1 University of Ottawa Heart Institute (Edwards, Li, Vaillancourt, K.B. Lewis, Stacey, Liu); School of Epidemiology and Public Health (Edwards, Pakhalé, Roumeliotis, Gravel, M. Lewis, Mehta, Liu), University of Ottawa, Ottawa, Ont.; Department of Medicine (McFarlane, Gilbert, Selby, Tu, Poon, Udell, Dhukai, Pasricha, Tobe), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Gilbert, MacIntosh, Swartz, Poon, Jain, Pham, Dhukai, Hua-Stewart, Tobe), Toronto, Ont.; LMC Diabetes & Endocrinology (Bajaj), Brampton, Ont.; Department of Medicine (Bittman, Virani), University of British Columbia, Vancouver, BC; Western University (Feldman); Department of Medicine (Dresser), Western University, London, Ont.; Humber River Hospital (Terenzi), Toronto, Ont.; Department of Medicine (Gabor), Concordia General Hospital, Winnipeg, Man.; Department of Cardiology (Gabor), Selkirk Regional Health Centre, Selkirk, Man.; Department of Medicine (Pearson), Division of Cardiology, University of Alberta, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Faculty of Education (Warburton), Indigenous Health & Physical Activity Program, University of British Columbia, Vancouver, BC; Department of Psychiatry (Styra, Baker, Hawkins), University of Toronto; Cardiovascular Division (Stone, Udell), Women's College Hospital; Department of Family and Community Medicine (Jain, Habert), Temerty Faculty of Medicine, University of Toronto; OCAD University (Jones), Toronto, Ont.; School of Architecture, Art and Design (Jones), Tecnológico de Monterrey, Mexico City, Mexico; Calgary Stroke Program, Departments of Clinical Neurosciences (Ganesh, Rabi, Campbell, Hill), Radiology and Community Health Sciences (Ganesh), the Hotchkiss Brain Institute (Ganesh, Rabi, Campbell, Hill), Cardiac Sciences and Libin Cardiovascular Institute (Sandhu), O'Brien Institute for Public Health (Ganesh), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Vancouver General Hospital (Andrade), Vancouver, BC; family physician (Stern), Oakville, Ont.; Department of Medicine and Research Centre (Rivard), Montreal Heart Institute, Université de Montréal, Montréal, Que.; Peter Munk Cardiac Centre (Udell), University Health Network, Toronto, Ont.; Department of Medicine (Gabor), Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, Montréal, Que.; Jewish General Hospital (Trudeau), McGill University, Montréal, Que.; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Department of Medicine (Cheng), McGill University, Montréal, Que.; School of Nursing (K.B. Lewis), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Northern Ontario School of Medicine University (Maar, Tobe), Sudbury, Ont.; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Public Health and Implementation Science (Oldenburg), La Trobe University and Baker Heart and Diabetes Institute, Melbourne, Australia; School of Nursing (Sherifali, Racey), McMaster University, Hamilton, Ont.; Department of Mathematics and Statistics (Gravel), and Data Literacy Research Institute (Gravel), University of Ottawa, Ottawa, Ont.; Health Informatics (Haider), University of Toronto, Toronto, Ont.; MarcLind Health Systems and Engagement Consulting (Lindsay), Toronto, Ont. jedwards@ottawaheart.ca.
2 University of Ottawa Heart Institute (Edwards, Li, Vaillancourt, K.B. Lewis, Stacey, Liu); School of Epidemiology and Public Health (Edwards, Pakhalé, Roumeliotis, Gravel, M. Lewis, Mehta, Liu), University of Ottawa, Ottawa, Ont.; Department of Medicine (McFarlane, Gilbert, Selby, Tu, Poon, Udell, Dhukai, Pasricha, Tobe), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre (Gilbert, MacIntosh

Background: Although brain and heart conditions share overlapping risk factors and commonly co-occur, current cardiac and neurologic clinical guidelines are typically produced within specialty silos. The objective of this guideline from a Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) panel is to expand on current cardiovascular guidelines to include evidence from the neurologic and mental health literature, with specific recommendations for providers managing comorbid brain and heart conditions.

Methods: The guideline development panel comprised an Executive Steering Committee; 10 expert subgroups to develop research questions and draft recommendations for specific brain-heart conditions; an Evidence Review Team to ensure the rigour and consistent application of the methodology; and an Implementation Committee to facilitate uptake of the recommendations by clinicians and into electronic medical records. The McMaster Evidence Review and Synthesis Team supported the literature searches and critical appraisal. A panel of people with lived experience of specific conditions and caregivers provided input on patient values and perspectives throughout the guideline development process. Our consensus process followed the Appraisal of Guidelines for Research and Evaluation II framework. We used an established evidence appraisal approach to determine the level of evidence and strength of each recommendation, and adhered to the Guidelines International Network's principles for managing competing interests.

Recommendations: We developed 11 recommendations for the management of joint brain and heart diseases. Key recommendations include screening for cognitive decline in atrial fibrillation and depression in coronary artery disease; treatment of depression in coronary artery disease, cognitive impairment in hypertension, and dyslipidemia in stroke; and vaccination to prevent stroke, myocardial infarction, and dementia. We also recommend shared decision-making, including the use of evidence-based decision aids, to support patients with heart-brain diseases.

Interpretation: We sought to produce an implementable and actionable guideline for patients with brain and heart comorbidity. It is primarily targeted to primary care providers, but also relevant to help address and individualize subspeciality care and for interprofessional teams caring for patients with joint brain and heart diseases.