Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.

© 2014 Canadian Medical Association or its licensors CMAJ, November 18, 2014, 186(17) 1299 In Canada, the multiple chronic conditions and cardiovascular risk factors of our aging population continue to challenge health care providers and burden health systems. Cardiovascular disease is a major contributor to chronic illness, with four in five Canadians having at least one risk factor for cardiovascular disease and 16% having three or more risk factors.1 In their first-line role, primary care practitioners bear a substantial proportion of the responsibility and patient care load associated with managing risk factors for cardiovascular disease. Clinical practice guidelines can assist health care practitioners by synthesizing the best available evidence with the use of robust procedures for guideline development, resulting in clear recommendations to guide medical decisionmaking. When this science of medicine intersects with the art of clinical practice, optimal patient care may result.2 In 2011, contributors to the Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) created Canada’s first harmonized guideline for cardiovascular risk factors.3 Using a consensus process, the 2011 C-CHANGE Guideline Panel accepted 89 key recommendations related to cardiovascular disease from more than 400 existing recommendations sourced from eight different guideline groups.3 The 2014 update is a harmonized subset of recommendations from the following guideline groups: Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment;4 Canadian Association of Cardiac Rehabilitation;5 Canadian Cardiovascular Society;6 Canadian Diabetes Association;7 Canadian Hypertension Education Program;8 Canadian Society for Exercise Physiology;9 Heart and Stroke Foundation Canadian Stroke Best Practice Recommendations;10 and Obesity Canada.11 The C-CHANGE Guideline Panel updates its harmonized guideline when the constituent guideline groups release new critically important recommendations or a sufficient number of guideline groups have updated their recommendations. The 2011 C-CHANGE guideline provided specific recommendations for screening, diagnostic and risk-stratification strategies, treatment targets, health-behaviour recommendations and pharmacologic treatments. Challenges in updating the C-CHANGE guideline include the varying time frames of updates and different grading schemes used by each guideline group. The opportunity presented by the C-CHANGE process includes both the harmonization of overlapping clinical practice recommendations from each of the member groups and the potential integration of the guideline development process. The primary aim of the 2011 C-CHANGE guideline was to develop the harmonization methodology and to produce the first set of harmonized recommendations for prevention and management of cardiovascular disease in primary care. The goal of this second iteration was to establish the integrated review cycle and to demonstrate that guideline groups with harmonized recommendations through C-CHANGE could work collectively to ensure that these recommendations would remain harmonized after the update.