Lignes directrices et mises à jour cliniques

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The Canadian medical community in general, and the Canadian Cardiovascular Society (CCS) in particular, have played a major role in promoting evidence based clinical practice in Canada. The Heart Failure Guideline Consensus Panel of the CCS published one of the first national guidelines on the clinical evidence for the diagnosis and treatment of heart failure in 1994 and published a comprehensive update in the Canadian Journal of Cardiology in December of 2001.'


However, since then, additional provocative but well conducted clinical trial evidence has emerged in the diagnosis and therapy for heart failure. For example, while the evidence is strong in its own right, devices such as automatic implantable defibrillators (AICDs) and point of care brain natriuretic peptide measurements have been approved for clinical use in Canada, yet their specific role in clinical practice has not been clearly defined. 

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Published CCS 2003 Consensus HF Update

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Heart failure remains a common diagnosis, especially in older individuals. It continues to be associated with significant morbidity and mortality, but major advances in both diagnosis and management have occurred and will continue to improve symptoms and other outcomes in patients. The Canadian Cardiovascular Society published its first consensus conference recommendations on the diagnosis and management of heart failure in 1994, followed by two brief updates, and reconvened this consensus conference to provide a comprehensive review of current knowledge and management strategies.

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Published in issue: January 2006

 

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Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations.

Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care.

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Published in issue: January 2007

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Heart failure is a clinical syndrome that normally requires health care to be provided by both specialists and nonspecialists. This is advantageous because patients benefit from complementary skill sets and experience, but can present challenges in the development of a common, shared treatment plan. The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006, and on the prevention, management during intercurrent illness or acute decompensation, and use of biomarkers in January 2007. The present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006 and 2007, several topics were identified as priorities because of the challenges they pose to health care professionals. 

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Published in issue: January 2008

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The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. 

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Published in issue: February 2009
 

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Since 2006, the Canadian Cardiovascular Society heart failure (HF) guidelines have published annual focused updates for cardiovascular care providers. The 2010 Canadian Cardiovascular Society HF guidelines update focuses on an increasing issue in the western world – HF in ethnic minorities – and in an uncommon but important setting – the pregnant patient. Additionally, due to increasing attention recently given to the assessment of how care is delivered and measured, two critically important topics – disease management programs in HF and quality assurance – have been included. Both of these topics were written from a clinical perspective. It is hoped that the present update will become a useful tool for health care providers and planners in the ongoing evolution of care for HF patients in Canada.

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Published in issue: April 2010

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The 2011 Canadian Cardiovascular Society Heart Failure (HF) Guidelines Focused Update reviews the recently published clinical trials that will potentially impact on management. Also reviewed is the less studied but clinically important area of sleep apnea. Finally, patients with advanced HF represent a group of patients who pose major difficulties to clinicians. Advanced HF therefore is examined from the perspectives of HF complicated by renal failure, the role of palliative care, and the role of mechanical circulatory support (MCS). All of these topics are reviewed from a perspective of practical applications. Important new studies have demonstrated in less symptomatic HF patients that cardiac resynchronization therapy will be of benefit. As well, aldosterone receptor antagonists can be used with benefit in less symptomatic HF patients. The important role of palliative care and the need to address end-of-life issues in advanced HF are emphasized. Physicians need to be aware of the possibility of sleep apnea complicating the course of HF and the role of a sleep study for the proper assessment and management of the conditon. Patients with either acute severe or chronic advanced HF with otherwise good life expectancy should be referred to a cardiac centre capable of providing MCS. Furthermore, patients awaiting heart transplantation who deteriorate or are otherwise not likely to survive until a donor organ is found should be referred for MCS.

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Published in issue: May-June, 2011

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The 2012 Canadian Cardiovascular Society Heart Failure (HF) Guidelines Update provides management recommendations for acute and chronic HF. In 2006, the Canadian Cardiovascular Society HF Guidelines committee first published an overview of HF management. Since then, significant additions to and changes in many of these recommendations have become apparent. With this in mind and in response to stakeholder feedback, the Guidelines Committee in 2012 has updated the overview of both acute and chronic heart failure diagnosis and management. The 2012 Update also includes recommendations, values and preferences, and practical tips to assist the medical practitioner manage their patients with HF.

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Published online: December 3, 2012

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The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides focused discussions on the management recommendations on 2 topics: (1) exercise and rehabilitation; and (2) surgical coronary revascularization in patients with heart failure. First, all patients with stable New York Heart Association class I-III symptoms should be considered for enrollment in a tailored exercise training program, to improve exercise tolerance and quality of life. Second, selected patients with suitable coronary anatomy should be considered for bypass graft surgery. As in previous updates, the topics were chosen in response to stakeholder feedback. The 2013 Update also includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers manage their patients with heart failure.

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Published online: October 28, 2013

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The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides discussion on the management recommendations on 3 focused areas: (1) anemia; (2) biomarkers, especially natriuretic peptides; and (3) clinical trials that might change practice in the management of patients with heart failure. First, all patients with heart failure and anemia should be investigated for reversible causes of anemia. Second, patients with chronic stable heart failure should undergo natriuretic peptide testing. Third, considerations should be given to treat selected patients with heart failure and preserved systolic function with a mineralocorticoid receptor antagonist and to treat patients with heart failure and reduced ejection fraction with an angiotensin receptor/neprilysin inhibitor, when the drug is approved. As with updates in previous years, the topics were chosen in response to stakeholder feedback. The 2014 Update includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers to best manage patients with heart failure.

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Published online: December 18, 2014

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The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF updates, including formal recommendations and supporting Practical Tips since 2006. Many clinicians indicate they routinely use the Canadian Cardiovascular Society HF Guidelines in their daily practice. However, many questions surrounding the actual implementation of the Guidelines into their daily practice remain. A consensus-based approach was used, including feedback from the Primary and Secondary HF Panels. This companion is intended to answer several key questions brought forth by HF practitioners such as appropriate timelines for initial assessments and subsequent reassessments of patients, the order in which medications should be added, how newer medications should be included in treatment algorithms, and when left ventricular function should be reassessed. A new treatment algorithm for HF with reduced ejection fraction is included. Several other practical issues are addressed such as an approach to management of hyperkalemia/hypokalemia, treatment of gout, when medications can be stopped, and whether a target blood pressure or heart rate is suggested. Finally, elements and teaching of self-care are described. This tool will hopefully function to allow better integration of the HF Guidelines into clinical practice.

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Published online: June 24, 2015

Mise à jour complète 2017 des Lignes directrices de la Société canadienne de cardiologie pour la prise en charge de l’insuffisance cardiaque

Le programme des lignes directrices sur l’insuffisance cardiaque (IC) de la Société canadienne de cardiologie (SCC) propose une orientation aux cliniciens, aux décideurs et aux systèmes de santé quant aux données probantes en matière de pratiques actuelles et nouvelles de prise en charge des patients atteints de ce trouble. La mise à jour de 2017 offre un ensemble complet de lignes directrices qui prennent en compte de nouvelles données et qui cernent les zones d’incertitude et de difficulté avec lesquelles les professionnels de la santé doivent composer lorsqu’ils prennent en charge des cas d’IC. Le document résume et actualise les lignes directrices des dix dernières années, en plus de prendre en compte une grande quantité de nouvelles recherches et de nouvelles données.

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Publié en ligne : 6 septembre 2017

The Need for Heart Failure Advocacy in Canada (pourquoi faut-il défendre la cause de l’insuffisance cardiaque au Canada?)

Depuis une dizaine d’années, le Comité des lignes directrices sur l’insuffisance cardiaque de la Société canadienne de cardiologie (SCC) et la SCC ont rédigé d’excellentes lignes directrices de pratique clinique ainsi que des outils d’application des connaissances. Ces ressources visent à offrir des soins optimaux aux patients atteints d’insuffisance cardiaque au pays. Même si la défense des intérêts en matière d’IC ne fait pas directement partie du mandat du Comité des lignes directrices, elle fait résolument partie du mandat de la Société canadienne d’insuffisance cardiaque (SCIC). L’article porte sur les principales difficultés qui nuisent aux progrès en matière de soins centrés sur les patients dans le domaine de l’IC au pays. Il lance un appel à l’action à l’intention de tous les intervenants et propose des objectifs de modification des systèmes de santé et d’initiatives en matière de politiques qu’il faut promouvoir si nous voulons changer profondément l’état des lieux relatif à ce problème de santé.

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Published online: September 11, 2017