CASP

1. You may decide to use CASP to screen individuals more comprehensively as part of your routine clinical practice, so you can assess many risk factors simultaneously. Screening at an early age rather than waiting for a health problem will promote early management of risk factors and prevention of disease.
2. You may decide to initiate comprehensive screening with individuals who have a family history of specific risk conditions e.g., familial hypercholesteremia, Type 2 diabetes mellitus, or hypertension) or if the physical assessment (e.g., elevated BP) may prompt you to initiate more comprehensive screening. Using CASP, you could screen for many other risk conditions simultaneously and provide your patient with their specific risk factors and cardiovascular status.
3. Individuals may ask you questions indicating interest in their cardiovascular health or stroke risk. If your patients are interested in learning about their risks for heart and brain health, take this opportunity to screen comprehensively for multiple risk factors and repeat periodically and follow up as appropriate in a proactive manner. Engagement of individuals is difficult, so having people who are already interested in improving their health is fantastic.

Ask your patients to complete the CASP Self-assessment by downloading the fillable PDF and bringing it back to you to discuss.

This is a separate self-assessment for individuals at risk for heart disease or stroke or already diagnosed but who would like to manage their risk factors proactively.

You can use the CASP Self-Assessment as a starting point as part of your focused CV health history in the next step in the CASP process.

Download CASP Self-Assessment

Review the CASP Self-Assessment that your patient completed as a starting point for your own assessment.

Use Visit 1 section of the CASP Screening Checklist to guide your focused history and physical assessment. Some of the CASP Screening Checklist items relate to the history and physical exam, while others relate to tests to order.

Using this checklist ensures that you will conduct a comprehensive CV assessment using a systematic approach.

Download CASP Screening Checklist

• Review the results of the history, physical exam, and blood work, and from this, identify the patient’s risk factors.

• For more information, use the following calculators:

  Framingham Risk Score (FRS):
  https://ccs.ca/frs/
  Note that this if for those who have never been diagnosed with heart disease or stroke.

  Heart Age:
https://www.heartfoundation.org.au/heart-age-calculator
  Enter a four-digit number for the postal code (e.g., 3127) to get the results.
  Note that communicating the Heart Age for younger individuals at higher risk may encourage positive health behaviour change.

• Additionally, you can help the patient calculate their life expectancy.
  https://www.projectbiglife.ca/life-expectancy-calculator
  https://www.projectbiglife.ca/cvd-calculator
• Identify if further assessment is needed, or a referral, and make the appropriate arrangements.

• Use the Decision Tree to identify relevant strategies that could be used to address the identified risk factors and management.
• Identify relevant resources that could be useful for the individual.
• Refer the individual as needed for specialized care.

Download the Decision Tree

• Review the test results, the identified risk factors, and management options with the individual.
• Together, you will choose priorities, establish heart and brain health goals, and create a plan of action and timely follow-up. Using shared decision-making is the key to success.
• CASP offers tools to help with communication, behaviour change and motivational interviewing, working with individuals to set goals using shared decision making, and a downloadable document for your patients to encourage them to set each goal with an action plan.

Download Communication Tips

Download Behaviour Change and Motivational Interviewing Guide

Download Goal Setting Guide

Download Heart and Brain Healthy Plan

Document the test results, goals, management options etc. in your usual documentation system.

Documenting CASP-Related Actions and Plans

1. Document the test results, goals, management options etc. in your usual documentation system. This may be paper based, the electronic health record (EHR) or Epic systems.
2. Be clear, relevant, and timely when documenting CASP-related interventions and include information about My Heart and Brain Healthy Plan such as dates and times for individuals goals.
3. Communicate about using shared decision-making and how you will track progress in helping the individual in meeting their personalized goals. Note patient preferences and values that influenced the decisions.
4. Track progress over time in follow-up notes, including changes in symptoms, adherence to lifestyle changes, medications, and non-pharm management.
5. If available, use templates or digital tools in the EHR to ensure consistency and effective communication with the interprofessional team.

Download checklist here

Ongoing Support for Individuals and Follow-up

• Provide education, counseling and support for individuals so they become more knowledgeable in implementing the action plan for managing the identified risk factors.
• Follow up with the individual, and provide ongoing support and further resources as appropriate, documenting progress, and any changes to the plan.
• Help individuals stay on track in their journey for heart and brain health and encourage them to stay in contact, so they are accountable and responsible for their actions and improving their health.