Special Article
Canadian Cardiovascular Society Consensus Conference guidelines on heart failure – 2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathiesMise à jour 2008 des lignes directrices de la conférence consensuelle sur l’insuffisance cardiaque de la Société canadienne de cardiologie : Meilleures pratiques pour la transition des soins des insuffisants cardiaques et le dépistage, l’exploration et le traitement des myocardiopathies

https://doi.org/10.1016/S0828-282X(08)70545-2Get rights and content

Heart failure is a clinical syndrome that normally requires health care to be provided by both specialists and nonspecialists. This is advantageous because patients benefit from complementary skill sets and experience, but can present challenges in the development of a common, shared treatment plan. The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006, and on the prevention, management during intercurrent illness or acute decompensation, and use of biomarkers in January 2007. The present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006 and 2007, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence that was adopted and previously described by the Society. Specific recommendations and practical tips were written for best practices during the transition of care of heart failure patients, and the recognition, investigation and treatment of some specific cardiomyopathies. Specific clinical questions that are addressed include: What information should a referring physician provide for a specialist consultation? What instructions should a consultant provide to the referring physician? What processes should be in place to ensure that the expectations and needs of each physician are met? When a cardiomyopathy is suspected, how can it be recognized, how should it be investigated and diagnosed, how should it be treated, when should the patient be referred, and what special tests are available to assist in the diagnosis and treatment? The goals of the present update are to translate best evidence into practice, apply clinical wisdom where evidence for specific strategies is weaker, and aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.

L’insuffisance cardiaque est un syndrome clinique qui exige normalement des soins de santé dispensés à la fois par des spécialistes et des non-spécialistes. Ce fonctionnement est avantageux, car les patients profitent d’ensembles de compétences et d’expérience complémentaires, mais il peut poser problème pour la mise sur pied d’un plan de traitement commun et partagé. En janvier 2006, la Société canadienne de cardiologie a publié une série complète de recommandations sur le diagnostic et la prise en charge de l’insuffisance cardiaque, et en janvier 2007, sur la prévention, la prise en charge pendant une maladie intercurrente et la décompensation aiguë et sur l’utilisation des biomarqueurs. La présente mise à jour se fonde sur ces recommandations de base. D’après les commentaires obtenus lors d’un programme national d’ateliers sur l’insuffisance cardiaque ayant eu lieu en 2006 et 2007, on a déterminé plusieurs sujets prioritaires en raison des défis qu’ils représentent pour les professionnels de la santé. On a élaboré de nouvelles recommandations probantes d’après la démarche structurée pour l’analyse et l’évaluation des données probantes que la Société a adoptée et déjà décrite. On a rédigé des recommandations précises et des conseils pratiques pour s’assurer des meilleures pratiques pendant la transition des soins des insuffisants cardiaques et le dépistage, l’exploration et le traitement des myocardiopathies. Les questions cliniques abordées sont : Quels renseignements le médecin traitant fournit-il en prévision d’une consultation auprès d’un spécialiste ? Quelles directives le consultant devrait-il donner au médecin traitant ? Quels processus devraient être en place pour s’assurer de respecter les attentes et les besoins de chaque médecin ? Quand on soupçonne la présence d’une myocardiopathie, comment peut-on la dépister, comment doit-on l’explorer et la diagnostiquer, comment faut-il la traiter, quand faut-il aiguiller le patient ailleurs et quels tests spéciaux peut-on utiliser pour contribuer au diagnostic et au traitement ? La présente mise à jour vise à transférer les meilleures données probantes en pratique, à appliquer la sagesse clinique lorsque les stratégies probantes sont moins solides et à aider les médecins et les autres dispensateurs de soins à traiter les insuffisants cardiaques de manière optimale, afin d’obtenir des effets mesurables sur la santé des patients et les issues cliniques au Canada.

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