Background

Under the priority topic of Ischemic Heart Disease, the College of Family Physicians of Canada
(CFPC) establishes the following as key objectives to understand for candidates seeking its
Certification in the College of Family Physicians of Canada (CCFP) designation:

1. Given a specific clinical scenario in the office or emergency setting, diagnose

presentations of ischemic heart disease (IHD) that are:
a. Classic
b. atypical (e.g., in women, those with diabetes, the young, those at no risk).
2. In a patient with modifiable risk factors for ischemic heart disease (e.g., smoking,
diabetes control, obesity), develop a plan in collaboration with the patient to reduce her
or his risk of developing the disease.
3. In a patient presenting with symptoms suggestive of ischemic heart disease but in whom
the diagnosis may not be obvious, do not eliminate the diagnosis solely because of tests
with limited specificity and sensitivity (e.g., electrocardiography, exercise stress testing,
normal enzyme results).
4. In a patient with stable ischemic heart disease manage changes in symptoms with self-
initiated adjustment of medication (e.g., nitroglycerin) and appropriate physician contact
(e.g., office visits, phone calls, emergency department visits), depending on the nature
and severity of symptoms.
5. In the regular follow-up care of patients with established ischemic heart disease,
specifically verify the following to detect complications and suboptimal control:
a. symptom control.
b. medication adherence.
c. impact on daily activities.
d. lifestyle modification
e. clinical screening (i.e., symptoms and signs of complications)
6. In a person with diagnosed acute coronary syndrome (e.g., cardiogenic shock,
arrhythmia, pulmonary edema, acute myocardial infarction, unstable angina), manage
the condition in an appropriate and timely manner.

Methods

A search of Ovid MEDLINE was conducted using the following search terms (Table 1). Results
were restricted to primarily Canadian literature. All Ovid MEDLINE entries from 1946 were
included in the search without restriction on publication date.
Table 1. Ovid MEDLINE search terms used to identify potentially relevant records.

# Search Terms Results

1 ("ischemic heart disease" and 8
(diagnosis or management or
treatment) and canada and
(guideline or recommendation or
review)).ab.
2 (("ischemic heart disease" or 93
"cardiovascular disease") and
(diagnosis or management or
treatment) and canada and
(guideline or recommendation or
review)).ab.
3 ("ischemic heart disease" and 52
(diagnosis or management or
treatment) and canada).ab.
4 ("acute coronary syndrome" and 9
(diagnosis or management or
treatment) and canada and
(guideline or recommendation or
review)).ab.
5 ("acute coronary syndrome" and 58
(diagnosis or management or
treatment) and canada).ab.
6 ("myocardial infarction" and 60
(diagnosis or management or
treatment) and canada and
(guideline or recommendation or
review)).ab.
7 ("ACS" and canada and 17
(guideline or recommendation or
review)).ab.
8 ((STEMI or NSTEMI) and 10
(diagnosis or management or
treatment) and canada and
(guideline or recommendation or
review)).ab.
9 (angina and (diagnosis or 16
management or treatment) and
canada and (guideline or
recommendation or review)).ab.
 10 ("unstable angina" and 7
(diagnosis or management or
treatment) and canada and
(guideline or recommendation or
review)).ab.
11 ("heart disease" and diabetes 11
and (diagnosis or management
or treatment) and canada and
(guideline or recommendation or
review)).ab.
12 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 261
or 9 or 10 or 11

Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE®
Daily and Ovid MEDLINE® <1946-Present>

Following the initial database search, duplicate records were removed. Records were then
screened for systematic reviews, meta-analyses, and clinical practice guidelines with
applicability to relevant CFPC objectives and Canadian practice settings. Publications which
have been superseded by more current publications (i.e. where a guideline has been updated or
replaced) were also excluded. See Figure 1 for the PRISMA flow diagram illustrating this.

Figure 1. PRISMA diagram outlining identification of studies included in qualitative

review.

Lastly, searches were conducted to identify other relevant information from UpToDate, the
Canadian Task Force on Preventative Care, and Canadian Cardiovascular Society.
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PRISMA Diagram Generation Tool

1. Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022).

PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow
diagrams, with interactivity for optimised digital transparency and Open Synthesis
Campbell Systematic Reviews, 18, e1230. https://doi.org/10.1002/cl2.1230