A groundbreaking initiative driven by the BHI and led by Drs. Sheldon Tobe, Peter Liu, and Jodi Edwards, alongside a full multidisciplinary team, is changing how brain–heart conditions are treated in clinical care. The team has published the first-ever Brain–Heart Clinical Practice Guideline, a foundational set of evidence-based recommendations for the screening and management of interconnected brain–heart diseases. Designed for national implementation and uptake, the guideline aims to significantly improve patient care and quality of life for those living with complex brain–heart conditions.
Harmonized Brain–Heart Care
The best healthcare relies on clear and unified standards, yet in practice, treatment approaches can vary, leading to inequitable outcomes for patients. This becomes especially pronounced in the presence of multimorbidity, where multiple conditions are present in one patient. There is growing evidence that heart and brain health are closely connected, with disease in one often increasing the risk of disease in the other. Despite this, brain and heart conditions are often treated as separate entities, further complicating consistency in care. Funded by the BHI, researchers have now developed and published the first Brain–Heart Clinical Practice Guideline to support primary care providers in addressing the interconnected nature of heart and brain health and improve the quality of patient care.
“This guideline was motivated by the growing recognition of the important connections between brain and heart diseases as a critical source of chronic disease in the aging populations. There is a close interplay between heart and brain diseases, with many comorbidities sharing overlapping risk factors, pathophysiological processes, and potential genetic and phenotypic connections. As a result, heart and brain conditions frequently co-occur and confer reciprocal increased risks," explains lead author, Dr. Edwards.
Brain–Heart Clinical Practice Guideline
The foundational Brain–Heart Clinical Practice Guideline was recently published in the Canadian Medical Association Journal, offering evidence-based and actionable recommendations for detecting and managing co-occurring brain and heart conditions (1). Moving beyond traditional frameworks that treat organs in isolation, this guideline takes a holistic approach, addressing the whole person and the complex connections between cardiovascular, neurological, and mental health. The program was led by Drs. Sheldon Tobe, Peter Liu, and Jodi Edwards, and co-produced with a multidisciplinary team that included cardiologists, neurologists, psychiatrists, primary care providers, and nurses. Importantly, patient partners with lived experience of brain and heart conditions were involved in every phase of developing the recommendations, ensuring they were grounded in real-world experience and aligned with patient priorities.
The guideline provides practical guidance for clinicians that can be easily integrated into everyday clinical practice. As Dr. Tobe highlights, "We hope this will be an implementable, actionable guideline that will help primary care providers as well as other health care professionals better manage patients with concurrent brain and heart diseases."
New Recommendations
The new brain–heart guideline includes 11 novel recommendations, all grounded in scientific and clinical research, addressing a range of interconnected cardiovascular and neurological conditions. The recommendations are divided into those focused on screening and those focused on treatment. Screening recommendations include assessing patients with atrial fibrillation (a type of irregular heartbeat) for risk of cognitive impairment, as well as screening patients with coronary artery disease for depression and implementing appropriate therapies when detected.
Recommendations focused on treatment include lowering blood pressure in patients at high cardiovascular risk to reduce cognitive impairment. They also include initiating cholesterol-lowering therapy to prevent heart attack in individuals with a history of stroke and to prevent stroke in those following a heart attack. The guideline further recommends routinely offering influenza, pneumococcal, and shingles vaccination to help prevent stroke, heart attack, and vascular cognitive impairment.
Finally, the guideline recommends that physicians provide patients with decision-support tools to help manage complex cardiovascular and neurological choices, enabling shared decision-making regarding their brain–heart care. The researchers also made a concerted effort to incorporate sex and gender considerations into each recommendation to ensure the guidance is relevant and applicable to all, while also highlighting limitations in the literature on sex differences. This approach helps address longstanding gaps in women’s brain and heart health.
C-CHANGE
The success and development of the Brain–Heart Clinical Practice Guideline is closely tied to C-CHANGE (Canadian Cardiovascular Harmonized National Guideline Endeavour), a long-standing national effort to create unified, evidence-based guidance for cardiovascular care. First released in 2011, C-CHANGE has issued regular updates as new evidence emerges (2–4). The Brain–Heart Clinical Practice Guideline was developed using the C-CHANGE process, allowing the work to draw on an experienced, multidisciplinary network while leveraging existing infrastructure, clinical reach, and national credibility to support broad adoption and impact.
The dissemination of the new Brain–Heart Clinical Practice Guideline is supported by the knowledge mobilization arm of C-CHANGE, CHEP+, which educates primary care providers through workshops, learning modules, clinical tools, and patient-facing resources. CHEP+ also hosts an annual conference to foster scientific collaboration and education, with the March 2026 conference in Toronto focused on the new brain–heart guideline. In addition, the BHI has partnered with the Eastern Ontario Health Unit (EOHU) to produce videos explaining the new recommendations. By leveraging these established platforms and audiences, the new guideline is well positioned to be translated into widespread clinical practice.
Impact of the Brain–Heart Clinical Practice Guideline
Chair and Scientific Director of the BHI, Dr. Peter Liu emphasizes the importance of the new guideline: "These recommendations recognize the intricate relationship between heart and brain disease and the importance of screening and treatment of the whole person, rather than a siloed approach. We hope this more holistic approach will be helpful to clinicians and offer a new way of developing clinical practice guidelines in a patient-centred manner."
The novel Brain–Heart Clinical Practice Guideline represent a transformative advancement in Canadian healthcare, supporting primary care providers and improving patient outcomes. They provide practical, evidence-based recommendations to help clinicians recognize and address co-occurring brain and heart conditions, reducing the future burden of these conditions across the population. This guideline marks a foundational shift, demonstrating the real-world connections between the brain and the heart, and translating research into actionable guidance for primary care. With their national reach and potential for international scalability, this guideline has the power to significantly impact patient care both in Canada and beyond.
As Dr. Julie St-Pierre, Vice-President of Research and Innovation at the University of Ottawa, highlights, “This guideline demonstrates the impact of the University of Ottawa’s leadership in advancing brain–heart research. By bringing together expertise from the Brain Heart Interconnectome and the C‑CHANGE network, this work helps redefine how we approach chronic disease management in Canada. We are proud to see research led at uOttawa shaping more integrated, patient‑centred care for the future.”
References
- Edwards JD, Li Z, McFarlane P, Rabi DM, Gilbert J, Bajaj HS, et al. Management of brain–heart multimorbidity: a clinical practice guideline. CMAJ. 2026 Mar 30;198(12):E425–39. doi:10.1503/cmaj.251137
- Jain R, Stone JA, Agarwal G, Andrade JG, Bacon SL, Bajaj HS, et al. Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2022 update. CMAJ. 2022 Nov 7;194(43):E1460–80. doi:10.1503/cmaj.220138
- Tobe SW, Stone JA, Anderson T, Bacon S, Cheng AYY, Daskalopoulou SS, et al. Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2018 update. CMAJ. 2018 Oct 9;190(40):E1192–206. doi:10.1503/cmaj.180194
- Tobe SW, Stone JA, Brouwers M, Bhattacharyya O, Walker KM, Dawes M, et al. Harmonization of guidelines for the prevention and treatment of cardiovascular disease: the C-CHANGE Initiative. CMAJ. 2011 Oct 18;183(15):E1135–50. doi:10.1503/cmaj.101508