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Evidence Synthesis Report
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Prepared by the Institute for Evidence-Based Healthcare, Bond University, Australia
New cardiovascular disease (CVD) Risk Guidelines were commissioned by the Australian Government Department of Health and Aged Care, and developed by the Heart Foundation on behalf of the Australian Chronic Disease Prevention Alliance (ACDPA) (Diabetes Australia, Kidney Health Australia and Stroke Foundation). The results of this literature search and evidence summaries were used to inform decision-making for the new Guideline for assessing and managing cardiovascular disease risk.
The project aim was to develop an updated CVD Risk clinical guideline and corresponding CVD risk prediction algorithm enabling best practice assessment and management of CVD risk, overseen by the Guideline Advisory Group which consists of representatives from the ACDPA.
To underpin this work, the National Health Foundation of Australia commissioned evidence summaries and GRADE appraisals for 12 initial questions that would inform an update to the Guidelines for the management of Absolute Cardiovascular Disease Risk 2012. These 12 initial questions were determined by the Expert Steering Group along with aspects of the scope and methods of the review, including a thorough documentation of the search strategy. Several of the question included multiple sub-questions. After discussion with the evidence review team, the initial 12 questions were subsequently reformulated into 33 PICO questions that could be answered by evidence.
These evidence summaries, and their GRADE assessments, aim to summarise the effectiveness of different management strategies for CVD risk, and the quality of the evidence for those effects. These evidence appraisals and summaries of the assessed literature will be used by the Expert Steering Group and working groups as the basis for recommendations to inform the development of the guidelines.
The guideline development process aligns with the Procedures and Requirements for meeting the 2016 NHMRC Standard for Clinical Practice Guidelines, including for searching the evidence and synthesising the evidence sections, with the GRADE approach used to assess the quality of the peer- reviewed literature.
This document provides an overall Methods section describing the general processes and the 33 PICO questions. The Summaries section provides a summary of the highest quality evidence that addressed each of the 33 questions, each structured as the Key reference(s), Methods Overview, Summary of Evidence, Conclusion, and Comments. A Supplement provides more detail for each individual question on its specific search processes and appraisal, and, where appropriate, GRADE Tables.
Summaries of the evidence
Summaries of the evidence are grouped into 5 topic areas: A) Risk factors and conditions, B) start age and interval, C) non-pharmacological strategies, D) pharmacological strategies, and E) risk communication.
The numbering convention aligns with the pre-specified question numbers. For example, A.6 is question in section A (Risk factors and conditions), number 6 “Should eGFR be used to re-classify an individual's risk of developing CVD (re-classify down or up) and if so, when should it be considered?”.
For additional information on the methods used to prepare the individual summaries, see the corresponding section in the “Supplementary” file (e.g., methods used to prepare A.6 is found in section A.6 of the Supplementary file)