Table 1:

Challenges of multiple guidelines for risk management of cardiovascular disease

Problem	Example	C-CHANGE approach
Redundancy	There are more than eight different recommendations for physical activity among the guidelines	Integrate to a single set of simple recommendation and remove all redundancies
Discordant recommendations	The Canadian Diabetes Association2 recommends target LDL cholesterol levels of ≤ 2.0 mmol/L, whereas the Canadian Cardiovascular Society3 recommends 50% reduction in LDL cholesterol levels or levels < 2.0 mmol/L, or apolipoprotein B levels < 0.8 g/L	Harmonize discrepant recommendations through review of evidence and consensus among all guideline developers to maximize impact and ease of implementation
Encyclopedic in scope	Guidelines of the Canadian Hypertension Education Program4 include detailed management of pheochromocytoma	Prioritize and simplify to include recommendations that have broad impact and influence on outcome
Different evidence bases	The Canadian Diabetes Association based its guidelines on evidence from 2008;2 the Canadian Cardiovascular Society used evidence from 2009;3 and the Canadian Hypertension Education Program used evidence from 20104	Share common evidence-gathering resources and synchronize formulation of the guideline
Different recommendations	The Canadian Diabetes Association does not recommend ASA for primary prevention in people with diabetes;2 the Canadian Hypertension Education Program does recommend ASA in people with hypertension4	Provide a common forum to harmonize recommendations
Different implementation strategies	Approach to lowering blood pressure differs among guidelines	Adopt the common best-practice strategies for implementation among all stakeholders

Note: ASA = acetylsalicylic acid, C-CHANGE = Canadian Cardiovascular Harmonization of National Guidelines Endeavour, LDL = low-density lipoprotein.