An innovative technology-based approach to translating clinical practice guidelines of nutrition therapy in primary care: The Cost, Health, and Effectiveness Assessment of the Portfolio diet in Primary care (CHEAPP) program

Cardiovascular disease results in 25% of deaths in Canada, costing over $21 billion annually. Nutrition and lifestyle remain the cornerstone of therapy for cardiovascular disease, but implementation is limited. Dietitian services in Canada are not covered by provincial health plans and most physicians cite a lack of education, tools and time to counsel on nutrition. Innovative self-management tools, such as web-based apps, provide a complementary and affordable approach for delivery of dietary advice, especially with the transition to virtual care during the COVID-19 pandemic. The Portfolio Diet, a plant-based dietary pattern of cholesterol-lowering foods which has demonstrated "drug-like" reductions in cholesterol and other cardiovascular risk factors, is uniquely positioned to test this innovative approach. We have developed the PortfolioDiet.app, as a direct translation of the Canadian Cardiovascular Society (CCS), Diabetes Canada, and Obesity Canada Clinical Practice Guidelines for the nutritional management of cholesterol. In collaboration with a unique and diverse group of experts in nutrition, cardiovascular disease, healthcare app development and evaluation, and health economics, and patient and physician advisory committees, we propose a 1-year trial to assess the clinical impact of the PortfolioDiet.app as add-on therapy to the standard of care (usual care) in individuals with high cholesterol in primary care. This intervention will demonstrate how clinical practice guidelines can be effectively translated using the PortfolioDiet.app to improve the cholesterol management and overall cardiovascular health while improving the patient and physician experience and reducing health care costs. The results will have a major influence on the translation of dietary guidelines, demonstrating the extent to which the Portfolio diet approach is an effective option for improving cardiovascular health and delivering a ready-to-use clinical tool in primary care.