Management of Brain-Heart Multimorbidity: A Clinical Practice Guideline

It reflects an intent to bridge specialty silos and provide actionable recommendations for providers managing comorbidity.

• Objective and scope: The guideline aims to extend cardiovascular guidance to incorporate neurologic and mental health perspectives, addressing co-occurring brain and heart conditions.

A McMaster team supported literature searching and appraisal, while input from people with lived experience and caregivers informed patient values and perspectives throughout development.

An established evidence appraisal approach determined the level of evidence and strength of recommendations, aligned with Guidelines International Network principles on managing competing interests.

• Multidisciplinary collaboration: A Canadian panel organized under the C-CHANGE framework included an Executive Steering Committee, ten expert subgroups, an Evidence Review Team, and an Implementation Committee.
• Methodological rigor: The guideline followed the Appraisal of Guidelines for Research and Evaluation II framework for consensus.

Additional targets include addressing cognitive impairment in hypertension, depression treatment in coronary artery disease, and dyslipidemia management in stroke.

• Comprehensive screening and condition-specific signals: The panel endorses cognitive decline screening in atrial fibrillation and depression screening in coronary artery disease.
• Prevention and vaccination emphasis: Recommendations underscore vaccination to prevent stroke, myocardial infarction, and dementia, highlighting a preventive dimension that spans both neurological and cardiovascular domains.
• Shared decision-making and decision aids: The guideline highlights patient-centered engagement, advocating shared decision-making supported by evidence-based decision aids to navigate management choices for individuals with heart–brain disease.

• Practical reach: The document is designed to be implementable and actionable, with primary relevance to primary care providers while also informing interprofessional teams and subspecialist care that addresses joint brain and heart disease.
• Integration into practice settings: An emphasis is placed on uptake within electronic medical records and routine clinical workflows, reflecting a translational aim from guideline development to real-world practice.

The scope indicates potential variability in applicability across settings not elaborated in the source text.

• Explicit gaps: The summary reflects the published recommendations and stated methodology; however, the provided content does not detail the exact evidence grades, the strength of each recommendation, or the precise numerical data behind the conclusions.