CMAJ · May 24, 2026

Management of heart–brain multimorbidity: a clinical practice guideline

By Edwards JD, Li Z, McFarlane P et al.

BACKGROUND: Heart diseases and brain diseases share various risk factors and often coexist; however, clinical practice guidelines in cardiology and neurology are most often produced in disciplinary silos. Developed by a group of experts from the C-CHANGE (Canadian Cardiovascular Harmonized National Guideline Endeavour) project, this clinical practice guideline aims to expand current recommendations on cardiovascular conditions to incorporate evidence from the neurology and mental health literature, as well as recommendations specifically intended for care providers who manage coexisting heart and brain conditions. METHODS: The writing committee that developed this clinical practice guideline included a steering committee; 10 expert subcommittees responsible for formulating research questions and drafting an initial version of the recommendations on specific heart–brain conditions; an evidence review team to ensure methodological rigor and consistent application of the methodology; and an implementation committee to facilitate clinicians’ adoption of the guideline recommendations and the integration of these recommendations into electronic medical records. The McMaster Evidence Review and Synthesis Team supported the literature searches and critical appraisal of the literature. A group of people with lived experience (PEV) of the conditions concerned, including caregivers, provided insight into patient values and perspectives throughout the development of this guideline. Our consensus process followed the principles of the Appraisal of Guidelines for Research and Evaluation II instrument. We used an established method of evidence assessment to determine the certainty of the evidence and the strength of each recommendation. Finally, we adopted the principles of the Guidelines International Network for managing competing interests. RECOMMENDATIONS: We formulated 11 recommendations on the management of various coexisting heart–brain diseases. The main recommendations include screening for cognitive decline in atrial fibrillation and for depression in coronary artery disease; treating depression in coronary artery disease, cognitive impairment in hypertension and dyslipidemia in stroke (AVC); and vaccination to prevent stroke, myocardial infarction and dementia. We also recommend shared decision-making, including the use of evidence-based decision aids, to support patients living with heart–brain diseases. INTERPRETATION: We sought to produce an applicable and practical clinical practice guideline for screening and managing patients living with heart–brain diseases. Our guideline is primarily intended for primary care providers, but it is also relevant to facilitating the delivery and individualization of subspecialty care and to assisting interprofessional teams caring for people with coexisting heart–brain diseases.

doi.org/10.1503/cmaj.251137-fOpen accessPubMed 42185004Industry & policy