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-heart conditions due to overlapping risk factors, common mechanistic pathways and genetic factors. Therefore, there has been a call for the use of more interdisciplinary approaches to the prevention and treatment of brain and heart conditions. In this paper, we report the consensus methodology for the development of the first Canadian Brain and Heart Clinical Practice Guidelines. The consensus panel included ten expert subgroups to develop research questions and recommendations for specific brain-heart conditions, the McMaster Evidence Review and Synthesis Team (MERST) to support the literature search, review and critical appraisal, and an Evidence Review Team (ERT) to ensure the rigour and consistent application of the methodology. The consensus process followed the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework, with 4 key stages: 1) MERST conducted systematic reviews and provided subgroups with data extraction and evaluation tools; 2) A consensus conference was held, with evidence and recommendations evaluated and voted on by all subgroups; 3) the ERT conducted a final review of evidence for each subgroup and determined the level and strength of each recommendation; 4) 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 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.