A new brain–heart clinical practice guideline takes a holistic approach, integrating neurologic and mental health evidence with guidance for cardiovascular disease as many brain and heart conditions overlap and share similar risk factors. The guideline is published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251137 .
Current clinical practice guidelines for cardiac, neurologic, and mental health conditions take disease-specific approaches, but many cardiovascular conditions co-occur with other diseases.
"This guideline was motivated by the growing recognition of the important connections between brain and heart diseases as a critical source of chronic disease in the aging populations," says lead author Dr. Jodi Edwards, director, Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario. "There is a close interplay between heart and brain diseases, with many comorbidities sharing overlapping risk factors, pathophysiological processes, and potential genetic and phenotypic connections. As a result, heart and brain conditions frequently co-occur and confer reciprocal increased risks."
Developed using the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) process with patient partners, the guideline provides evidence-based practical guidance for primary care professionals, subspecialists, allied health teams, and patients with cardiovascular risk factors. It also focuses on sex and gender considerations for each recommendation.
The guideline makes 11 recommendations, including
- Screening people with atrial fibrillation for risk of cognitive decline
- Screening for depression in people with coronary artery disease and treating with evidence-based therapies, if detected
- Initiating intensive blood pressure lowering in people at increased cardiovascular risk to lower the risk of cognitive impairment
- Starting intensified cholesterol lowering to prevent heart attack in people with a history of stroke, and to prevent stroke in people following a myocardial infarction
- Routinely offering influenza, pneumococcus, and shingles vaccination, especially to people aged 65 years and older, to help prevent stroke, heart attack, and vascular cognitive impairment
- Using patient decision aids to facilitate guideline implementation
"These recommendations recognize the intricate relationship between heart and brain disease and the importance of screening and treatment of the whole person, rather than a siloed approach," says Dr. Peter Liu, a cardiologist at the University of Ottawa Heart Institute, and chair and scientific director of the Brain–Heart Interconnectome, a research initiative of the University of Ottawa funded through the Canada First Research Excellence Fund.
"We hope this more holistic approach will be helpful to clinicians and offer a new way of developing clinical practice guidelines in a patient-centred manner."
To help with implementation, the team has created a range of tools for clinicians and patients, including infographics and decision aids, which can be found at www.ottawaheart.ca .
"We hope this will be an implementable, actionable guideline that will help primary care providers as well as other health care professionals better manage patients with concurrent brain and heart diseases," says Dr. Sheldon Tobe, a nephrologist at Sunnybrook Health Sciences Centre and co-chair and cofounder of the C-CHANGE initiative, with Dr. Liu.
This research was undertaken with funding from the Canada First Research Excellence Fund for the University of Ottawa Brain–Heart Interconnectome research program.
