Canadian Cardiovascular Society urges medical community to adopt new recommendations for treatment of heart failure, cardiorenal disease, dyslipidemia and atrial fibrillation
OTTAWA – January 24, 2023 – Four sets of clinical care Guidelines, systematically released over recent months by the Canadian Cardiovascular Society (CCS), hold the potential to transform cardiovascular care in Canada and save thousands of lives, says Society president Dr. Michelle Graham, Director of the Division of Cardiology at the University of Alberta.
“Guidelines include important, lifesaving information that needs to get into the hands of frontline clinicians across the country,” says Dr. Jonathan Howett, CCS member, Chair of the CCS Guidelines Committee and cardiologist with the Libin Cardiovascular Institute of Alberta. “The impact of these new Guidelines is powerful.”
Based on rigorous work by the CCS expert panels, who reviewed trials and research from around the world, revised Guidelines call for:
- a revolutionary new multi-drug approach to the treatment of heart failure. More than 600,000 Canadians are living with heart failure and more than 90,000 people are diagnosed with the condition each year;
- the use of two classes of glucose-lowering medications to treat cardiorenal disease. The potential benefit of wider access to these new drugs could be felt by as many as three million Canadians living with heart failure, chronic kidney disease, and/or type 2 diabetes;
- new targets for the management of dyslipidemia, or elevated cholesterol. Dyslipidemia affects most Canadians at some point in their lives and is the leading cause of atherosclerosis, or clogged blood vessels; and,
- a holistic approach to the detection and prevention of atrial fibrillation (AF). As many as a million Canadians live with atrial fibrillation, an irregular rhythm or rapid heart rate.
What’s new and exciting about the heart failure guidelines is a recommendation to administer all four standard drug therapies “right out of the gate” to people with HFrEF (Heart Failure with reduced Ejection Fraction, a condition where the left side of the heart is pumping poorly), instead of using a stepped approach, says Dr. Sean Virani, head of cardiology at Providence Health Care in Vancouver and co-chair of the panel.
“With this new approach, we will see thousands of patients in Canada with improved outcomes. On the ground, we are seeing the benefits of it literally every day,” Dr. Virani says. “It flattened our previous algorithm of how patients with heart failure are treated. It is transformative. We are really ahead of the curve globally.”
Two classes of drugs commonly prescribed to lower glucose levels in people with type 2 diabetes (GLP-1RA and SGLT2i) have been shown to reduce hospitalization and death in patients with heart failure and chronic kidney disease, whether they have diabetes or not, according to the new cardiorenal protection guideline.
“These drugs need to be integrated early into patient management plans to reap the best long-term benefits,” says panel co-chair Dr. John Mancini, Professor of Medicine at the University of British Columbia. “We can prolong lives; we can prevent major adverse cardiovascular events; and we can protect the kidney.”
Aggressive new approaches to reduce cholesterol-related heart disease are part of an extensive update of dyslipidemia prevention and treatment guidelines. “Dyslipidemia is one of the major risk factors in the development and progression of atherosclerotic cardiovascular disease.” says Professor of Medicine Dr. Glen Pearson of the University of Alberta, expert panel co-chair.
Recommendations include one-time blood testing in the general population for lipoprotein(a) (Lp(a)), a risk factor for cardiovascular disease; use of effective new lipid-lowering medications, including injectables, to treat people who do not achieve adequate control on statin therapy; measurement of non-fasting biomarkers apolipoprotein B (ApoB) or non-high density lipoprotein (non-HDL) as an alternative to low-density lipoprotein (LDL), particularly in people with high trigyclerides; and, a recommendation against the use of over-the-counter omega-3 fish-oil supplements because they have no cardiovascular benefit.
In what is the most robust revision of practice recommendations in a decade, the Canadian atrial fibrillation (AF) guidelines advocate for considering AF as a manifestation of larger and more complex cardiovascular disease. The most effective way to tackle AF is through a comprehensive approach that considers the impact of AF on symptoms and quality of life, the adverse consequences of AF, such as stroke, and the significant contribution of cardiovascular risk factors and concomitant risk conditions, says Vancouver cardiologist and Guidelines co-chair Dr. Jason Andrade. “This is a major philosophical shift that will be transformative in further improving outcomes for Canadians affected by atrial fibrillation.”
In additional to foundational care, such as stroke prevention and symptoms control, the Guidelines place strong emphasis on management of high blood pressure, diabetes, obesity, physical inactivity, sleep apnea, and other risk factors. Recommendations also call for dedicated multidisciplinary clinics to treat people with AF in a holistic way to improve overall health and wellbeing.
Knowledge translation helps integrate Guidelines into patient care
The CCS knowledge translation activities, resources and tools help Canadian cardiovascular health professionals integrate the Guidelines into patient care. Our programs focus on awareness and education as well as handy reference tools and resources. Current activities and resources include online webinars, pocket reference guides, educational slide decks, calculators, and worksheets. Visit our resources here: https://ccs.ca/guideline-resources/
About the Canadian Cardiovascular Society
The CCS is the national voice for cardiovascular clinicians and scientists, representing more than 2,300 cardiologists, cardiac surgeons and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. Visit: https://www.ccs.ca/en/.
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Tel: (613) 799-9057