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12-09-2011 | Cardiology | Article

New harmonized guidelines facilitate primary care of CVD


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MedWire News: Canadian researchers have created a new set of harmonized guidelines that they believe will facilitate the primary care and management of cardiovascular disease (CVD).

The new recommendations are designed to be consistent, scientifically rigorous, nonredundant, and to positively influence health outcomes, report Peter Liu (University of Toronto, Canada) and co-authors in the Canadian Medical Association Journal.

They explain that having multiple guidelines can inhibit implementation, understanding, and adherence to recommendations, thereby hindering the delivery of clinically effective guideline-based care.

The Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE) initiative used a consensus model to harmonize and integrate over 400 recommendations from eight separate guidelines into 89 key recommendations for the management of cardiovascular risk factors.

Broadly, the C-CHANGE recommendations cover risk stratification, treatment targets, healthy behaviors, and interventions.

Liu et al recommend that the risk for future cardiovascular events in all patients older than 40 years should be determined every 1-3 years using established scoring systems. Additionally, individuals with a positive family history of CVD before the age of 60 years or those belonging to high-risk ethnic groups should be assessed more frequently.

Secondly, they say that treatment targets should be based on the individual patient's level of risk. For example, in a patient with high cardiometabolic risk, effective reduction of blood pressure in the short-term should be a high priority, whereas reducing weight and increasing physical activity should be long-term priorities, Liu et al explain.

Thirdly, physicians must recommend healthy behaviors to all patients, including smoking cessation, adhering to a diet capable of promoting energy balance and a healthy body weight, as well as adequate weekly physical activity.

Furthermore, say the authors, a combination of modifications to health behaviors and pharmacologic interventions will be required in most patients who are at high and moderate risk for cardiovascular events, to meet treatment targets.

"The gaps in knowledge, along with the existing and potential gaps in treatment identified through this harmonization process provide a distinct opportunity to align and integrate guidelines for the management of chronic disease in a manner that effectively consolidates, rather than confuses, patient care," conclude Liu and team.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Piriya Mahendra

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