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At least 19 recordsLinked to original sources
PubMed2005

Canadian Cardiovascular Society and Canadian Thoracic Society position statement on pulmonary arterial hypertension.

The Canadian Cardiovascular Society and the Canadian Thoracic Society requested a position statement on pulmonary arterial hypertension from leading Canadian experts. The present document is intended to act as an update for the clinician, to provide a template for the initial evaluation of patients, to enable understanding of current therapeutic paradigms based on approved indications for Canada, to highlight new therapies on the horizon, and to state the positions of the Canadian Cardiovascular Society and the Canadian Thoracic Society on resource management for pulmonary arterial hypertension in Canada.

Canada↗
PubMed2005

Canadian Cardiovascular Society and Canadian Thoracic Society position statement on pulmonary arterial hypertension.

The Canadian Cardiovascular Society and the Canadian Thoracic Society requested a position statement on pulmonary arterial hypertension from leading Canadian experts. The present document is intended to act as an update for the clinician, to provide a template for the initial evaluation of patients, to enable the understanding of current therapeutic paradigms based on approved indications for Canada, to highlight new therapies on the horizon, and to state the positions of the Canadian Cardiovascular Society and the Canadian Thoracic Society on resource management for pulmonary arterial hypertension in Canada.

Humans↗
PubMed1996

Recommendations for ensuring early thrombolytic therapy for acute myocardial infarction. The Heart and Stroke Foundation of Canada, the Canadian Cardiovascular Society and the Canadian Association of Emergency Physicians for the Emergency Cardiac Care Coalition.

OBJECTIVE: To recommend practical steps to ensure early thrombolytic therapy and thereby reduce mortality and morbidity associated with acute myocardial infarction (AMI). OPTIONS: Various factors were considered that influence time to thrombolysis related to patients, independent practitioners and health care systems. OUTCOMES: Reduction in morbidity and mortality associated with AMI. EVIDENCE: Early initiation of thrombolytic therapy reduces morbidity and mortality associated with AMI. The ECC Coalition analysed the factors that might impede early implementation of thrombolytic therapy. VALUES: Published data were reviewed, and recommendations were based on consensus opinion of the Emergency Cardiac Care (ECC) Coalition. The ECC Coalition comprises 20 professional, nongovernment and government organizations and has a mandate to improve emergency cardiac care services through collaboration. BENEFITS, HARMS AND COSTS: Early thrombolytic therapy reduces morbidity and mortality associated with AMI. Implementation of the recommendations will result in reduced time to thrombolytic therapy, streamlining of current practices and enhanced cooperation among health care professionals to expedite care. Depending on existing practices, implementation may require protocol development, and public and professional education. Although costs are associated with educating the public and health care professionals, they are outweighed by the financial and social benefits of reduced morbidity and mortality. RECOMMENDATIONS: Early recognition of AMI symptoms by the public and health care professionals, early access to the emergency medical services system and early action by emergency care providers in administering thrombolytic therapy (within 30 minutes after the patient's arrival at the emergency department). VALIDATION: No similar consensus statements or practice guidelines for thrombolytic therapy in Canada are available for comparison.

Emergency Medical Services↗
PubMed1991

Report of the Canadian Cardiovascular Society's consensus conference on the Management of the Postmyocardial Infarction Patient.

In October 1989, the Canadian Cardiovascular Society announced a program to achieve consensus on important issues in the care of patients with cardiovascular disease. This report on the management of the postmyocardial infarction patient represents the first in a series of these consensus conferences. The process for establishing consensus recommendations involved several steps. A primary panel of 11 experts from various fields was selected to review the available clinical evidence and to make a list of recommendations about management decisions in the postmyocardial infarction period. The initial report was distributed to a secondary panel of 16 reviewers* representing allied health care constituencies from across Canada. On the basis of the critical reviews and feedback from these reviewers, a revised report was distributed to all members (over 800) of the Canadian Cardiovascular Society for further review and feedback. This iterative approach resulted in a penultimate report that was presented at a plenary session of the annual scientific meeting of the Canadian Cardiovascular Society on Oct. 18, 1990, in Halifax, NS. On the basis of discussion and feedback from this symposium, the consensus review was completed.

Canada↗
PubMed2005

Canadian Cardiovascular Society commentary on implantable cardioverter defibrillators in Canada: waiting times and access to care issues.

The Canadian Cardiovascular Society is the national professional society for cardiovascular specialists and researchers in Canada. In the spring of 2004, the Canadian Cardiovascular Society Council formed an Access to Care Working Group in an effort to use the best science and information to establish reasonable triage categories and safe wait times for access to common cardiovascular services and procedures. The Working Group has elected to publish a series of commentaries to initiate a structured national discussion on this very important issue. Access to treatment with implantable cardioverter defibrillators is the subject of the present commentary. The prevalence pool of potentially eligible patients is discussed, along with access barriers, regional disparities and waiting times. A maximum recommended waiting time is proposed and the framework for a solution-oriented approach is presented.

Canada↗
PubMed1997

Medical treatment of heart failure: the Canadian Cardiovascular Society's Consensus Conference revisited.

The report of the Canadian Cardiovascular Society's Consensus Conference on the diagnosis and management of heart failure was published in 1994. Focusing on the chronic medical treatment of patients with systolic left ventricular dysfunction, we summarize and update the consensus recommendations in the light of the results of several more recent studies. While the positive treatment recommendations are still fully valid or even reinforced by these new data, a somewhat more liberal use of beta-blockers, amiodarone, and newer calcium channel blockers seems justified.

Adrenergic beta-Antagonists↗
PubMed2004

Canadian Cardiovascular Society classification of effort angina: an angiographic correlation.

BACKGROUND: The Canadian Cardiovascular Society classification (CCSC) remains the standard for grading angina in patients with chronic stable angina. The utility value of this angina grading system in predicting the severity of coronary artery disease is not clear. AIM: We studied the relationship between the clinical angina grade and the angiographic severity of underlying coronary artery disease. MATERIALS AND METHODS: The participants in the study were 493 patients with stable angina who had undergone coronary angiography from 1998 to 2001. They were grouped according to their anginal grading and the number of vessels diseased. Significant lesions were defined as 50% narrowing for the left main and 70% for the left and right coronaries and their major branches. STATISTICAL ANALYSIS: The chi2-test was used for statistical analysis and a P-value <0.05 was taken as significant. RESULTS: There was no significant difference between the four angina class patients and the incidence of single-, double- and triple-vessel involvement. Class 1 patients had less left main trunk disease than class 4 patients. Class 3 and 4 patients had significantly fewer normal coronary angiograms. CONCLUSIONS: There is generally little correlation between coronary artery disease and the CCSC of effort angina except for left main disease. Presence or absence of angina rather than the CCSC should indicate the need for coronary angiography.

Angina Pectoris↗
PubMed2002

The Canadian Cardiovascular Society grading of angina pectoris revisited 30 years later.

BACKGROUND: The Canadian Cardiovascular Society (CCS) grading of angina pectoris was described in the medical literature in 1976. OBJECTIVES: To describe the origin of this grading, its worldwide acceptance, critiques, perceived limitations and alternative systems. METHODS: The present author, who chaired the CCS ad hoc committee that developed this grading system in 1972, used documentation based on personal correspondence, and information from medline and international citation indexes searches. RESULTS: The CCS committee's mandate was to standardize the definition of terms used in reporting studies of coronary artery disease and coronary artery bypass graft surgery. The committee defined a four-level system modelled on the New York Heart Association functional classification of patients with diseases of the heart, and the American Medical Association classes of organic heart diseases. Threshold activities that produced angina were detailed to assess reliably the severity of exertional angina by independent observers, and changes over time. The grading system has been cited over 650 times in the literature since its official publication in 1976. Although this grading system was found to be generally relevant and practical, several imperfections and potential limitations were reported, the most pertinent being the criterion "anginal syndrome may be present at rest" included in grade IV, which was found to be inappropriate and confusing. The prognostic significance of the grading system, despite the finding that this was not its primary goal, was also thought to be inadequate. CONCLUSION: Although this grading system of the severity of effort angina has been accepted throughout the world over the past 30 years, a revision is desirable considering its potential imperfections and inconsistencies with present day management of ischemic heart disease.

Angina Pectoris↗
PubMed2002

Effects of the 1994 Canadian Cardiovascular Society clinical practice guidelines for congestive heart failure.

BACKGROUND: In 1994, the Canadian Cardiovascular Society (CCS) issued practice guidelines for the management of congestive heart failure (CHF), which strongly recommended the use of angiotensin-converting enzyme (ACE) inhibitors. OBJECTIVE: To compare a strategy of active implementation of the CCS guidelines for CHF with the usual passive approach on the use of ACE inhibitors in hospitalized patients with CHF. PATIENTS AND METHODS: The study was conducted in eight Canadian hospitals close to the time of release of the CCS guidelines for CHF in the summer of 1994. The patients comprised those who were admitted to the participating hospitals with a diagnosis of CHF during the study period. Active dissemination included stakeholder development of pocket cards outlining an algorithm for the management of CHF based on the CCS guidelines and was conducted at the two Edmonton, Alberta hospitals. The cards were widely disseminated in conjunction with a series of workshops and presentations. Passive dissemination occurred at six other hospitals, and involved only the distribution of the CCS guidelines in the usual fashion (with no structured dissemination program). The primary outcome measured was the use of ACE inhibitors in the six- to 12-month period before the release of the CCS guidelines, compared with after the release in the active and passive groups. RESULTS: In the active group, hospital records of 1170 patients with CHF were reviewed before, and 1279 were reviewed after, the release of the CCS guidelines. In the passive group, 3436 were reviewed before, and 1912 were reviewed after the release of the guidelines. ACE inhibitor use did not change significantly in the active group (52.4% before versus 50.9% after) or in the passive group (53.4% before versus 56.5% after). CONCLUSIONS: Neither the active nor passive approaches to the dissemination of the CCS guidelines for CHF had any impact on the use of ACE inhibitors in hospitalized patients with CHF. Further efforts to package, deliver and evaluate guidelines are needed.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2005

Canadian Cardiovascular Society Consensus Conference: peripheral arterial disease - executive summary.

This Consensus Conference has been supported by the Canadian Cardiovascular Society. The process is dynamic, with intentional structure that requires peer review and feedback from cardiovascular specialists across Canada. The writing and review panel encompassed a broad range of specialists caring for the patient with peripheral arterial disease (PAD). PAD is an often asymptomatic, underdiagnosed, under-recognized and undertreated condition. It is associated with significant morbidity and cardiac mortality. Until recently, little attention has focused on the evaluation and treatment of the disease process itself. The goal of the present paper is to ensure better treatment, to reduce both morbidity and mortality in the patient with vascular disease and, importantly, to serve as a guide to the busy clinician. Although the focus is PAD, there are chapters on thoracic and abdominal aortic disease, renal arterial disease and the evidence supporting management. Screening and diagnostic techniques including history and physical examination as well as noninvasive imaging techniques are reviewed. Medical management for patients with vascular disease including prevention and risk reduction is graded based on evidence, including both pharmacological and nonpharmacological management strategies, followed by an introduction to newer percutaneous techniques. Finally, surgical treatment for claudication including new concepts on the perioperative risk assessment for patients undergoing major vascular surgery is discussed.

Aortic Aneurysm↗
PubMed2004

The 2004 ACC/AHA Guidelines: a perspective and adaptation for Canada by the Canadian Cardiovascular Society Working Group.

Major changes in acute ST elevation myocardial infarction (STEMI) management prompted a comprehensive rewriting of the American College of Cardiology/American Heart Association Guidelines. The Canadian Cardiovascular Society (CCS) participated in both the writing process and the external review. Subsequently, a Canadian Working Group (CWG), formed under the auspices of the CCS, developed a perspective and adaptation for Canada. Herein, accounting for specific realities of the Canadian cardiovascular health system, is a discussion of the implications for prehospital care and transport, optimal reperfusion therapy and an approach to decision making regarding reperfusion options and invasive therapy following fibrinolytic therapy. Major recent developments regarding indications for implantable cardioverter defibrillator(s) (ICDs) also prompted a review of indications for ICDs and the optimal timing of implantation given the potential for recovery of left ventricular function. At least a 40-day, preferably a 12-week, waiting period was judged to be optimal to evaluate left ventricular function post-STEMI. A recommended algorithm for the insertion of an ICD is provided. Implementation of the new STEMI guidelines has substantial implications for resources, organization and priorities of the Canadian health care system. While on the one hand, the necessary incremental funding to provide tertiary and quaternary care and to support revascularization and device implantation capability is desirable, it is equally or more important to develop enhanced prehospital care, including the capacity for early recognition, risk assessment, fibrinolytic therapy and/or triage to a tertiary care centre as part of an enlightened approach to improving cardiac care.

Canada↗
PubMed2004

The Canadian Cardiovascular Society and knowledge translation: turning best evidence into best practice.

Care gaps, the discrepancy between processes of care recognized as best practice and care provided in usual clinical practice, exist in cardiovascular disease. Knowledge translation, the process of turning best evidence into best practices, has the potential to reduce care gaps. As the national voice for cardiovascular physicians and scientists, the Canadian Cardiovascular Society is committed to knowledge translation. The present article describes how knowledge translation builds on the constructs of continuing medical education and continuing professional development; what can be done to improve knowledge translation; and what the Canadian Cardiovascular Society is currently doing about this.

Attitude of Health Personnel↗
PubMed1992

The Canadian Cardiovascular Society grading scale for angina pectoris: is it time for refinements?

OBJECTIVE: To appraise the measurement properties of the Canadian Cardiovascular Society (CCS) classification of stable angina pectoris. DATA SOURCES: Relevant articles were identified through a MEDLINE search (1976 to November 1991). Bibliographies of retrieved articles were also reviewed. STUDY SELECTION: Studies chosen directly addressed the validity and reliability of the CCS scale. Recent studies and reviews of related topics (for example, silent ischemia) are selectively cited. DATA SYNTHESIS: No data address the scale's applicability, that is, how clinicians typically assign angina grades in practice. Comprehensiveness would be improved by coverage of the patient's perceptions of symptom burden; mixed exertional and rest symptoms; episodic or changing symptoms; and modifying factors. Reliability was assessed in one study with two clinicians; the interobserver, chance-corrected agreement on patient grading was 60%. Content validity (the ability of the scale to measure what it claims) is threatened by the unproven assumption of symptomatic or physiologic equivalence among diverse levels of different activities within any given grade of angina. Construct validity is uncertain, given weak relations between angina grade and noninvasive markers of ischemia, anatomical disease, or prognosis. The scale's responsiveness (the ability to detect the smallest clinically important changes) is limited by the reliance on four coarse gradations based on only ambulation or stair-climbing. CONCLUSIONS: The CCS scale for stable angina might be made more useful by developing measurements for patients' self-rated symptom burden and the changes they deem important; by adding items on clinical instability (that is, progressive symptoms or pain at rest); and by empirically testing the current scale to eliminate redundant or inconsistent elements.

Angina Pectoris↗
PubMed1992

The internal logic of the Canadian Cardiovascular Society scale for grading angina pectoris: a first appraisal.

OBJECTIVE: To assess the internal logic (content validity) of the Canadian Cardiovascular Society (CCS) scale for grading angina pectoris. PATIENTS: Forty-one consenting patients with stable angina of at least two months duration, admitted to a tertiary centre for coronary angiography. METHODS: Patients completed a supervised questionnaire with closed-ended questions. Key questions included: usual numbers of blocks walked on the level or flights of stairs climbed before onset of chest pain; frequency with which chest pain occurred at the usual threshold distance; presence of rest pain; and influence of modifiers suggested for class II of the scale such as walking uphill and into the wind. RESULTS: Agreement of four questionnaire-defined 'stair-climbing grades' and 'walking grades' was statistically significant (P < 0.001) but only 37% better than expected by chance alone (weighted kappa). Frequency of angina at a patient's self-defined exercise threshold varied; only 22 of 41 patients (54%) had symptoms always or often. Higher classes of angina were more likely to be associated with frequent symptoms at threshold, eg, class I/II, six of 23 versus class III/IV, 16 of 17; 2P = 0.00002). Pain at rest was reported as 'definitely' present by 23 of 41 patients, and was similar in incidence across angina classes. All suggested modifiers reduced distances walked in a significant majority of patients (P values uniformly < 0.01) except for walking in the first few hours after awakening. However, the proportions of subjects for whom these factors were relevant were statistically similar for all angina grades, rather than for class II patients alone. CONCLUSIONS: These findings suggest that internal inconsistencies in the CCS scale are identifiable with simple validity checks. Further research appears warranted to improve this popular and useful clinical tool.

Adult↗
PubMed2006

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management.

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. New clinical trial evidence and meta-analyses were critically reviewed by a multidisciplinary primary panel who developed both recommendations and practical tips, which were reviewed by a secondary panel. The resulting document is intended to provide practical advice for specialists, family physicians, nurses, pharmacists and others who are involved in the care of heart failure patients. Management of heart failure begins with an accurate diagnosis, and requires rational combination drug therapy, individualization of care for each patient (based on their symptoms, clinical presentation and disease severity), appropriate mechanical interventions including revascularization and devices, collaborative efforts among health care professionals, and education and cooperation of the patient and their immediate caregivers. The goal is to translate best evidence-based therapies into clinical practice with a measureable impact on the health of heart failure patients in Canada.

Canada↗
PubMed2006

Canadian Cardiovascular Society position statement--recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease.

Since the last publication of the recommendations for the management and treatment of dyslipidemia, new clinical trial data have emerged that support a more vigorous approach to lipid lowering in specific patient groups. The decision was made to update the lipid guidelines in collaboration with the Canadian Cardiovascular Society. A systematic electronic search of medical literature for original research consisting of blinded, randomized controlled trials was performed. Meta-analyses of studies of the efficacy and safety of lipid-lowering therapies, and of the predictive value of established and emerging risk factors were also reviewed. All recommendations are evidence-based, and have been reviewed in detail by primary and secondary review panels. Major changes include a lower low-density lipoprotein cholesterol (LDL-C) treatment target (lower than 2.0 mmol/L) for high-risk patients, a slightly higher intervention point for the initiation of drug therapy in most low-risk individuals (LDL-C of 5.0 mmol/L or a total cholesterol to high-density lipoprotein cholesterol ratio of 6.0) and recommendations regarding additional investigations of potential use in the further evaluation of coronary artery disease risk in subjects in the moderate-risk category.

Canada↗