The inclusion of cognition in vascular risk factor clinical practice guidelines

Figures & data

Table 1 Characteristics of clinical practice guidelines included in the review

Association	Year	Vascular risk factor	Target population
American College of Chest Physicians^Citation36	2004	Atrial fibrillation	Not specified
American Academy of Family Physicians, American College of Physicians^Citation38	2003	Atrial fibrillation: First-detected	Adults with first-detected atrial fibrillation
American College of Cardiology, American Heart Association, European Society of Cardiology^Citation37	2001	Atrial fibrillation	Not specified
California Healthcare Foundation, American Geriatrics Society^Citation26	2003	Diabetes	Older persons
Us Preventive services Task Force^Citation41	2003	Diabetes: diabetes mellitus	Adults (diabetes mellitus)
Agencé Nationale d’Accréditation et d’Évaluation en Santé^Citation28	2000	Diabetes: type 2 diabetes	Type 2 diabetics without complications
Canadian Cardiovascular Society^Citation42	2006	Cholesterol: dyslipidemia
American Diabetes Association^Citation23	2004	Cholesterol: dyslipidemia	Adults with diabetes
National Cholesterol Education Program^Citation30	2002	Cholesterol: high blood cholesterol	Adults
American Diabetes Association^Citation24	2004	Hypertension	Adults with diabetes
American Hypertension Association^Citation33	2008	Hypertension	Adults
Canadian Hypertension Education Program^Citation29	2007	Hypertension therapy	Adults
Canadian Hypertension Education Program^Citation32	2007	Hypertension: diagnosis and risk	Adults
European Society of Hypertension^Citation39	2007	Hypertension: arterial	Not specified
Joint National Committee-727	2003	Hypertension: high blood pressure	Not specified
National Collaborating Centre for Chronic Conditions^Citation31	2006	Hypertension	Not specified
South African Hypertension Society^Citation34	2006	Hypertension	Adults
Us Preventative Services Task Force^Citation40	2003	Hypertension: high blood pressure	Adults
Agencé Nationale d’Accréditation et d’Évaluation en Santé^Citation25	2005	Hypertension	Adults
American Geriatrics Society^Citation35	2001	Anticoagulants (Warfarin)	Older people

Table 2 A comparison of the vascular risk factor clinical practice guidelines that mentioned cognition (n = 5) to those that did not (n = 15)

Questions	Answer	Mentioned cognition?
		Yes	No
Is there a description of the individuals who were involved in the guidelines development?	Yes	4	1
	No	5	10
Were there representatives of all relevant disciplines?	Yes	3	2
	No	3	3
Is the search strategy described?	Yes	2	3
	No	6	9
Are descriptive studies included?	Yes	3	0
	No	7	2
Is there a description of the methods used to interpret and asses the strength of the evidence?	Yes	2	3
	No	12	3
Is there an explicit link between the recommendations and the level of supporting evidence?	Yes	3	2
	No	14	1
Are recommendations made for ongoing monitoring of condition and complications?	Yes	5	0
	No	10	5
Does the guideline discuss compliance?	Yes	3	2
	No	4	11
Does the guideline mention claudication?	Yes	4	1
	No	2	13
Does the guideline mention renal function?	Yes	5	0
	No	12	3
Is pheochromocytoma mentioned?	Yes	2	3
	No	2	13

Table

	Quality of the guideline	Y	N	N/A
1	Are the guidelines peer-reviewed? If no, eliminate from further review.
2	Is the agency responsible for the development of the guidelines clearly identified?
3	Was external support received?
4	Did it include pharmaceutical support? If no, skip to 5
4a	If pharmaceutical support was received, did the company(s) who provided support manufacture or distribute drugs that treat cognitive impairment?
5	Is there a description of the individuals who were involved in the guidelines development? If no, skip to 6
5a	If so, were there representatives of all relevant disciplines? Comments:
6	Is there a description of the search strategy used to select the studies on which the recommendations are based? If no, skip to 7
6a	If so, does the evidence include descriptive studies as well as randomized controlled trials?
7	Is there a description of the method(s) used to interpret and assess the strength of the evidence? Comments:
8	Is there an explicit link between the major recommendations and the level of supporting evidence? Comments:
9	Is there a description of the patients to whom the guidelines are meant to apply? Comments:

Table

	Content of the guideline	Y	N	N/A
1	Does the guideline mention claudication?
2	Does the guideline mention cognitive impairment? If no, skip to 3.
2a	If yes to 2, does the guideline discuss how to screen for cognitive impairment?
3	Does the guideline mention renal function? If no, skip to 4.
3a	If yes to 3, does the guideline discuss how to screen for renal function?
4	Does the guideline discuss target organ damage? If no, skip to 5.
4a	If yes to 4, does the guidelines mention cognitive impairment as an aspect of target organ damage?
5	Does the guidelines include outcomes? If no, skip to 6.
5a	If yes to 5, does the guideline mention claudication as an outcome? If yes to 5, does the guideline mention cognitive impairment as an outcome? If yes to 5, does the guideline mention renal function as an outcome?
6	Does the guideline cite evidence for outcomes that are likely to benefit from the recommended management? If no, skip to 7.
6a	If so, does the guideline cite evidence or otherwise suggest that cognition is likely to benefit from the recommended management?
7	Are recommendations made for ongoing monitoring of the principle condition and complications? If no, skip to 8.
7a	If so, do these recommendations include assessment of cognition?
8	Was cognition mentioned as a risk factor (exposure) for any vascular outcome? If no, skip to 9.

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