Consensus Methodology for the Canadian Brain and Heart Clinical Practice Guidelines

Brain and heart diseases are leading causes of morbidity and mortality globally. Emerging evidence suggests a close interplay between brain and heart conditions, due to overlapping risk factors, common mechanistic pathways, and genetic factors. Therefore, a call has been made for the use of more interdisciplinary approaches to the prevention and treatment of brain and heart conditions. In this paper, we report on the consensus methodology used for the development of the first Canadian brain and heart clinical practice guidelines. The consensus panel included 10 expert subgroups, to develop research questions and recommendations for specific brain-heart conditions, the McMaster Evidence Review and Synthesis Team, to support the literature search, review, and critical appraisal, and an evidence review team to ensure the rigor and consistent application of the methodology. The consensus process followed the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework, with the following 4 key stages: (i) the McMaster Evidence Review and Synthesis Team conducted systematic reviews and provided subgroups with data extraction and evaluation tools; (ii) A consensus conference was held, with evidence and recommendations evaluated and voted on by all subgroups; (iii) the evidence review team conducted a final review of evidence for each subgroup and determined the level and strength of each recommendation; and (iv) final recommendations and evidence levels were submitted to all subgroups for ratification and approval by the steering committee. This paper summarizes and describes the consensus methods used to evaluate and integrate evidence from both the cardiac and neurological medical literature for the development of the first Canadian brain and heart clinical practice guidelines.