Several new guidelines and position papers offering the most up to date information to ensure that clinicians practice evidence-based medicine were released at the Canadian Cardiovascular Congress 2009 this week.
Among them are the following:
- 2009 CCS Canadian Cholesterol Guidelines
- 2009 CCS Consensus Conference Update on the Guidelines for the Management of Adults with Congenital Heart Disease
- CCS/Canadian Association of Radiologists Consensus Training Standards for Cardiac CT
- 2009 CCS Heart Failure Guidelines
Guidelines are one of the highest priorities of the Canadian Cardiovascular Society (CCS), says their president Dr. Charles Kerr. "They are one of our most important services and are the highest rated by clinicians," he says. "For example, the CCS heart failure guidelines website has received a huge number of hits this year − in the hundreds of thousands. They have an enormous impact."
The CCS usually puts out one set of guidelines each year. This year, the CCS guidelines committee, chaired by Dr Michelle Graham, coordinated the release of 10 guidelines and position statements.
The guidelines are an invaluable resource not only for members of the cardiovascular community, but for family physicians and nurse practitioners throughout Canada, she says.
Dr. Graham praises the dedication and drive of all of the contributors to the guidelines and position statements who went above and beyond the call of duty to produce rigorous, evidence based guidelines. "This is volunteerism at its best, with a view of improving the heart health of Canadians."
Guideline Highlights
2009 CCS Canadian Cholesterol Guidelines − Chaired by Dr. Jacques Genest
A joint effort with the Canadian Vascular Coalition and CIHR, the 2009 cholesterol guidelines have better defined secondary and high-risk prevention strategies and include clinical studies on end-stage disease (advanced heart failure and hemodialysis).
What's new:
- With regard to primary prevention, the 2009 cholesterol guidelines include cardiovascular risk evaluation tools and the Framingham Risk Score for cardiovascular disease.
- Intermediate risk is defined as a FRS 10-19% 10-year risk and family history is now part of risk stratification.
- hsCRP is part of the risk stratification in intermediate risk subjects.
- Simplified target levels.
- Secondary targets evaluated according to available evidence.
What doctors need to know:
For patients at high risk (those with CAD, PVD, atherosclerosis, most patients with diabetes, FRS>20%, RRS>20%)
- Consider treatment in all patients
- Primary LDL-C target < 2mmol/L or 50% reduction in LDL-C
For moderate risk patients (FRS 10-19%), initiate treatment if:
- LDL-C > 3.5 mmol/L.
- TC/HL-C > 5.0.
- hsCRP>2 in men >50 y and women > 60 y.
- Family history and hsCRP modulates risk (RRS).
- Primary target Class 1 level A recommendation is LDL-C < 2mmol/L or 50% reduction of LDL-C.
2009 Updated Guidelines for the Management of Adults with Congenital Heart Disease − Chaired by Dr. Candice Silversides
With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease has grown and in the current era there are more adults with congenital heart disease than children. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with congenital heart disease, there have been significant advances in our understanding of the late outcomes, genetics, medical therapy, and interventional approaches in the field of adult congenital heart disease. The updated guidelines for the management of adult congenital heart disease address these important issues.
What doctors need to know:
- Adults with congenital heart disease have a unique set of needs including genetic screening, antibiotic prophylaxis, and pregnancy/contraception.
- Other issues specific to adults with congenital heart disease include long-term and multisystemic effects of single ventricle physiology, cyanosis, systemic right ventricles, complex intracardiac baffles, and failing subpulmonary right ventricles.
- Complications in this population include distinctive forms of heart failure, pulmonary hypertension, thromboemboli, complex arrhythmias, and sudden death.
- Recommendations for medical therapy and indications for interventions for the common congenital cardiac lesions are available in the CCS 2009 Updated Guidelines for the Management of Adults with Congenital Heart Disease.
Canadian Cardiovascular Society/Canadian Association of Radiologists Consensus Training Standards for Cardiac CT - Co-chaired by Dr. Benjamin Chow (CCS) and Dr. Carole Dennie (CAR)
What's new:
- Standards for training in cardiac CT have been developed as a consensus of the Canadian Association of Radiologists and the Canadian Cardiovascular Society and apply to both radiologists and cardiologists with the mutual goal of optimizing patient care.
Cardiac risk assessment prior to the use of stimulant medications in children and youth: a joint position statement by the Canadian Pediatric Society, the Canadian Cardiovascular Society, and the Canadian Academy of Child and Adolescent Psychiatry − CCS writing group chair is Dr. Andrew Warren
What doctors need to know: