Ottawa Heart Institute creates new guidelines for treating heart, brain and mental health issues

New guidelines out of the University of Ottawa Heart Institute may shape how doctors in Canada treat heart, brain and mental health conditions.

Dr. Jodi Edwards, director of the Brain and Heart Nexus Research Program at the University of Ottawa Heart Institute, led the development of the guidelines and says they encourage family physicians to treat heart, brain and mental health conditions together rather than in isolation.

“If someone comes in with some flutter in their heart, it could be something called ‘atrial fibrillation,’ and that’s the most common cardiac cause of stroke. So, now, the primary care provider will know to screen for stroke risk in the context of the heart disease,” Edwards told CTV News.

The guidelines are being published in the Canadian Medical Association Journal, which reaches physicians throughout Canada.

“This will have high impact across the country, to all family physicians, subspecialists and the public and will ultimately improve outcomes for Canadians as a whole,” Edwards said.

Edwards says the guidelines are focused on disease prevention, which will help prevent patients from having to undergo major surgeries or treatments.

According to Edwards, patients suffering from mental health conditions are more likely to have cardiovascular conditions, and the opposite is true as well, which these guidelines consider.

“So now, this will just give providers some treatment recommendations,” Edwards said. “If people come in with heart disease, they’ll know that they need to also think about and manage their mental health, so that people can properly adhere to their treatment plans and have better outcomes.”

The guidelines were created by bringing together heart and brain research, which Edwards says is a novel approach. The guidelines were also developed by incorporating patient input and gender and sex recommendations.

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The guidelines

The new recommendations provide physicians with a ten-step program to guide patients through the screening, treatment and shared decision-making processes.

The guidelines are as follows:

1. Screening: Screen patients with atrial fibrillation for risk of cognitive impairment.
2. Screening: Screen the patients with coronary artery disease for depression.
3. Treatment: Treat depression in coronary artery disease with evidence-based therapy.
4. Treatment: Intensively lower systolic blood pressure in high-risk patients to reduce cognitive impairment.
5. Treatment: Intensify LDL-cholesterol treatment in coronary artery disease above guideline threshold.
6. Treatment: Intensify LDL-cholesterol treatment after stroke above guideline threshold.
7. Treatment: Offer influenza vaccination to reduce risk of stroke and cardiovascular death.
8. Treatment: Offer pneumococcal vaccination to reduce risk of myocardial infarction and stroke.
9. Treatment: Offer herpes zoster (shingles) vaccination to reduce risk of stroke, myocardial infarction and dementia.
10. Shared decision-making: Use evidence-based decision aids to support shared decision-making in brain-heart care.