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ACP Preoperative Cardiac Risk Assessment

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1. ACP Preoperative Cardiac Risk Assessment

ACP Preoperative Cardiac Risk Assessment ACP Preoperative Cardiac Risk Assessment Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 ACP (...) Preoperative Cardiac Risk Assessment ACP Preoperative Cardiac Risk Assessment Aka: ACP Preoperative Cardiac Risk Assessment II. Background Replaced by Listed for historical reasons only III. Criteria: Eagle and Vanzetto Age over 70 years Q waves on ECG History of History of History of ventricular ectopy History of ST segment abnormalities on EKG with IV. Protocol Indications for surgery without further evaluation Young healthy patient undergoing minor surgery Noncardiac emergency surgery Class I Risk Index

2018 FP Notebook

2. ACP Preoperative Cardiac Risk Assessment

ACP Preoperative Cardiac Risk Assessment ACP Preoperative Cardiac Risk Assessment Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 ACP (...) Preoperative Cardiac Risk Assessment ACP Preoperative Cardiac Risk Assessment Aka: ACP Preoperative Cardiac Risk Assessment II. Background Replaced by Listed for historical reasons only III. Criteria: Eagle and Vanzetto Age over 70 years Q waves on ECG History of History of History of ventricular ectopy History of ST segment abnormalities on EKG with IV. Protocol Indications for surgery without further evaluation Young healthy patient undergoing minor surgery Noncardiac emergency surgery Class I Risk Index

2015 FP Notebook

3. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

(Updated Figure 4 From the 2014 VHD guideline). *MV repair is preferred over MV replacement when possible? AF indicates atrial fibrillation; CAD, coronary artery disease; CRT, cardiac resynchronization therapy; EF, ejection fraction; ERO, effective regurgitant orifice; HF, heart failure; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; MR, mitral regurgitation; MV, mitral valve; NYHA, New York Heart Association; PASP, pulmonary artery (...) ? Circulation? 2008;117:3118–25? 25? Geist SM, Fitzpatrick S, Geist JR? American Heart Association 2007 guidelines on prevention of infective endocarditis? J Mich Dent Assoc? 2007;89:50–6? Downloaded from http://ahajournals.org by on March 27, 2019Nishimura et al June 20/27, 2017 Circulation. 2017;135:e1159–e1195. DOI: 10.1161/CIR.0000000000000503 e1182 26? Duval X, Alla F, Hoen B, et al? Estimated risk of endocarditis in adults with predisposing cardiac conditions undergoing dental procedures

2017 American Heart Association

4. Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease Full Text available with Trip Pro

Figure 1 AUC Development Process 2217 3. Assumptions 2218 General Assumptions 2218 Assumptions for Rating Multiple Treatment Options 2219 4. Definitions 2219 Table A. Revascularization to Improve Survival Compared With Medical Therapy 2220 Table B. Noninvasive Risk Stratification 2222 5. Abbreviations 2223 6. Coronary Revascularization in Patients With Stable Ischemic Heart Disease: Appropriate Use Criteria (By Indication) 2223 Section 1. SIHD Without Prior CABG 2223 Table 1.1 One-Vessel Disease 2224 (...) SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing

2017 Society for Cardiovascular Angiography and Interventions

5. AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart.

in the standard methods of risk assessment but are thought to contribute to coronary artery disease risk. ? Selection of the optimal diagnostic work-up for evaluation or exclusion of coronary artery disease should be made within the context of available studies (which include treadmill stress test, stress myocardial perfusion imaging, stress echocardiography, cardiac PET imaging and invasive cardiac/coronary angiography), so that the resulting information facilitates patient management decisions and does (...) of risk assessment, such as the SCORE (Systematic Coronary Risk Evaluation) or the Framingham risk score calculation. These risk calculation systems include consideration of the following factors: Age Sex Abnormal Lipid Profile Hypertension Diabetes Mellitus (always = high risk) Cigarette Smoking Other coronary risk factors such as family history of premature CAD, coronary artery calcification, C reactive protein levels, obesity, etc., are not included in the standard methods of risk assessment

2019 AIM Specialty Health

6. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular (...) Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation

2016 American Heart Association

7. Is there a difference in PAC versus no-PAC in surgical cardiac and ICU patients?

cross-sectional 1,2 , one was a randomised control trial 3 , one was a cohort study 4 , and one was a case-control study 5 . Two studies involved all types of cardiac surgery patients (e.g. coronary artery bypass grafting and heart valve surgery) 1,2 . Two studies involved coronary artery bypass graft patients only 3,5 , and one study involved neurointensive care-trauma patients, cardiac surgery patients, and general surgery/transplant patients all in the intensive care unit (ICU) 4 . The systematic (...) . For coronary artery bypass graft patients, in-hospital costs for the entire hospitalisation were higher in PAC patients compared to no-PAC patients 5 . There are no differences in separate preoperative, intraoperative and post-operative costs between PAC patients and no-PAC patients 5 . For cardiac surgery patients, recent reports have stated that there is a difference in cost between PAC versus no-PAC with PAC costing US $133,000 and no-PAC costing US$125,000 2 . Figure 8. Cost of care of PAC versus

2017 Monash Health Evidence Reviews

8. Adults With Congenital Heart Disease

, medical therapy, myocardial infarction, noncardiac surgery, patent ductus arteriosus, perioperative care, physical activity, postoperative complications, pregnancy, preoperative assessment, psychosocial, pulmonary arterial hypertension, hypoplastic left heart syndrome, pulmonary regurgitation, pulmonary stenosis, pulmonary valve replacement, right heart obstruction, right ventricle to pulmonary artery conduit, single ventricle, supravalvular pulmonary stenosis, surgical therapy, tachyarrhythmia (...) innominate vein, and right upper pulmonary vein(s) connecting high on the superior vena cava. Long-term sequelae of anomalous pulmonary venous connections reflect the impact of right heart volume overload and are similar to the sequelae of ASDs. Surgical repair can be challenging as low-velocity venous flow imparts risk of thrombosis of the surgically operated vein. See Section 3.3 for recommendations on who should perform surgeries, cardiac catheterization, and other procedures in these patients

2018 American College of Cardiology

9. AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart

., are not included in the standard methods of risk assessment but are thought to contribute to CAD risk. ? Selection of the optimal diagnostic work-up for evaluation or exclusion of coronary artery disease should be made within the context of available studies (which include treadmill stress test, stress myocardial perfusion imaging, stress echocardiography, cardiac PET imaging and invasive cardiac/coronary angiography), so that the resulting information facilitates patient management decisions and does (...) Perfusion Imaging Pre-operative cardiac evaluation of patients undergoing non-cardiac surgery This guideline applies to patients undergoing non-emergency surgery. It is assumed that those who require emergency surgery will undergo inpatient preoperative evaluation. ? Patients with active cardiac conditions such as unstable coronary syndromes (unstable angina), decompensated heart failure (NYHA function of class IV, worsening or new onset heart failure), significant arrhythmias (third degree AV block

2018 AIM Specialty Health

10. ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay

. Evaluation of Conduction Disorders 86 7.5. Management of Conduction Disorders (With 1:1 Atrioventricular Conduction) 92 8. Special Populations 95 8.1. Perioperative Management 95 8.1.1. Patients at Risk for Bradycardia During Noncardiac Surgery or Procedures 95 8.1.2. Postoperative Bradycardia and Conduction Disorders After Cardiac Surgery 96 8.2. Bradycardia Management for Adult Congenital Heart Disease 107 8.3. Management of Bradycardia in Patients With an Acute MI 109 8.4. Neurologic Disorders 111 (...) -elevation acute coronary syndromes AHA/ACC 2014 (S1.4-9) Heart failure ACC/AHA 2013 (S1.4-10) ST-elevation myocardial infarction ACC/AHA 2013 (S1.4-11) Device-based therapy for cardiac rhythm abnormalities ACC/AHA/HRS 2013 (S1.4-2) Coronary artery bypass graft surgery ACC/AHA 2011 (S1.4-12) Hypertrophic cardiomyopathy ACC/AHA 2011 (S1.4-13) Percutaneous coronary intervention ACC/AHA/SCAI 2011 (S1.4-14) Guidelines for CPR and emergency cardiovascular care—part 9: post-cardiac arrest care AHA 2010 (S1.4

2018 American College of Cardiology

11. Valvular Heart Disease (Focused Update): Guidelines For the Management of Patients With

considered, a heart valve team consisting of an integrated, multidisciplinary group of healthcare professionals with expertise in VHD, cardiac imaging, interventional cardiology, cardiac anesthesia, and cardiac surgery should collaborate to provide optimal patient care. 2014 recommendation remains current. I B-NR SurgicalARisrecommendedforsymptomaticpatients with severe AS (Stage D) and asymptomatic patients with severe AS (Stage C) who meet an indication for AVR when surgical risk is low or intermediate (...) . J Mich Dent Assoc. 2007;89:50–6. 26. Duval X, Alla F, Hoen B, et al. Estimated risk of endocarditis in adults with predisposing cardiac con- ditions undergoing dental procedures with or without antibioticprophylaxis.ClinInfectDis.2006;42:e102–7. Nishimura et al. JACC VOL. 70, NO. 2, 2017 2017 VHD Focused Update JULY 11, 2017:252–89 27627. The 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015;36:3036–7. 28. Horstkotte D, Rosen H, Friedrichs W, Loogen F

2017 American College of Cardiology

12. Management of Patients on Non?Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

, no conclu- sions regarding coronary artery bypass grafting–related care can be made. Established indications for NOACs in the pericardiac surgery setting include stroke prevention in preoperative AF, prolonged or frequent postoperative AF, and VTE treatment. NOAC use is contraindicated in patients with mechanical valves; as the RE-ALIGN (The Randomized, Phase II Study to Evaluate the Safety and Pharmacoki- netics of Oral Dabigatran Etexilate in Patients After Heart Valve Replacement) trial (...) Heart Association Clinical Pharmacology Subcommittee of the Acute Cardiac Care and General Cardiology Committee of the Coun- cil on Clinical Cardiol- ogy; Council on Car- diovascular Disease in the Young; and Council on Quality of Care and Outcomes Research Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting A Scientific Statement From the American Heart Association © 2017 American Heart Association, Inc. Key Words: AHA Scientific

2017 American Heart Association

13. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

aortic stenosis); nonischemic myocardial injury (e.g., myocarditis, cardiac contusion, cardiotoxic drugs); and multifactorial causes that are not mutually exclusive (e.g., stress [Takotsubo] cardiomyopathy [Section 7.13], pulmonary embolism, severe heart failure [HF], sepsis) (41). 3. Initial Evaluation and Management 3.1. Clinical Assessment and Initial Evaluation: Recommendation Class I 1. Patients with suspected ACS should be risk stratified based on the likelihood of ACS and adverse outcome(s (...) prediction algorithms using clinical history, physical examination, ECG, and cardiac troponins have been developed to help identify patients with ACS at increased risk of adverse outcome(s). Common risk assessment tools include the TIMI (Thrombolysis In Myocardial Infarction) risk score (42), the PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) risk score (43), the GRACE (Global Registry of Acute Coronary Events) risk score (44), and the NCDR

2014 Society for Cardiovascular Angiography and Interventions

14. Dual Antiplatelet Therapy in Patients With Coronary Artery Disease (Focused Update)

, compared with aspirin monotherapy, result in differencesin mortality rate, decreased nonfatal MI, decreased MACE, and/or increased bleeding? ACS indicates acute coronary syndrome; DAPT, dual antiplatelet therapy; DES, drug- eluting stents; MACE, major adverse cardiac events; MI, myocardial infarction; NSTEMI, non–ST-elevation myocardial infarction; PICOTS, population, intervention, comparison, outcome, timing, and setting; SIHD, stable ischemic heart disease; and STEMI, ST-elevation myocardial (...) ,andsomefactorsareassociatedwithboth increased ischemic and bleeding risk, making it dif?cult in many patients to assess the bene?t/risk ratio of pro- longed DAPT. A new risk score (the “DAPT score”), derived from the Dual Antiplatelet Therapy study, may be useful for de- cisions about whether to continue (prolong or extend) DAPT in patients treated with coronary stent implanta- tion. Analysis of study data suggests that in patients treated for 1 year with DAPT without signi?cant bleeding or ischemic events, the bene?t/risk ratio

2016 American College of Cardiology

15. Cardiac Screening With Electrocardiography, Stress Echocardiography, or Myocardial Perfusion Imaging: Advice for High-Value Care From the American College of Physicians

. Chou. Final approval of the article: R. Chou. Collection and assembly of data: R. Chou. Abstract Background: Cardiac screening in adults with resting or stress electrocardiography, stress echocardiography, or myocardial perfusion imaging can reveal findings associated with increased risk for coronary heart disease events, but inappropriate cardiac testing of low-risk adults has been identified as an important area of overuse by several professional societies. Methods: Narrative review based (...) on published systematic reviews; guidelines; and articles on the yield, benefits, and harms of cardiac screening in low-risk adults. Results: Cardiac screening has not been shown to improve patient outcomes. It is also associated with potential harms due to false-positive results because they can lead to subsequent, potentially unnecessary tests and procedures. Cardiac screening is likely to be particularly inefficient in adults at low risk for coronary heart disease given the low prevalence and predictive

2015 American College of Physicians

16. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

or statements and will not be discussed further here: Patients with heart failure and/or reduced ejection fraction Patients who have experienced sudden cardiac death or sustained ventricular arrhythmia Patients undergoing preoperative cardiovascular evaluation for noncardiac surgery (including solid organ transplantation) Evaluation of cardiac disease among patients who are kidney or liver transplantation candidates , Note that ACC/AHA guidelines for coronary angiography were published in 1999 (...) for diagnosis and risk stratification is the appropriate initial study. Importantly, coronary angiography is appropriate only when the information derived from the procedure will significantly influence patient management and if the risks and benefits of the procedure have been carefully considered and understood by the patient. Coronary angiography to assess coronary anatomy for revascularization is appropriate only when it is determined beforehand that the patient is amenable to, and a candidate

2014 American Heart Association

17. Non-ST-Elevation Acute Coronary Syndromes: Guideline For the Management of Patients With

, hypertension, tachycardia, hypertrophic cardiomyopathy, severe aortic stenosis); nonischemic myocardial injury (e.g., myocarditis, cardiac contusion, cardiotoxic drugs); and multifactorial causes that are not mutually exclusive (e.g., stress [Takotsubo] cardiomyop- athy [Section 7.13], pulmonary embolism, severe heart failure [HF], sepsis) (41). 3. INITIAL EVALUATION AND MANAGEMENT 3.1. Clinical Assessment and Initial Evaluation: Recommendation CLASS I 1. Patients with suspected ACS should be risk strati (...) scores and clinical prediction algorithms using clinical history, physical examination, ECG, and cardiac troponins have been developed to help identify patients with ACS at increased risk of adverse outcome(s). Common risk assessment tools include the TIMI (Throm- bolysis In Myocardial Infarction) risk score (42),thePUR- SUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) risk score (43),the GRACE(GlobalRegistryofAcute Coronary Events) risk score

2014 American College of Cardiology

18. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes Full Text available with Trip Pro

, antihypertensives, anti-ischemic therapy, antiplatelet therapy, antithrombotic therapy, beta blockers, biomarkers, calcium channel blockers, cardiac rehabilitation, conservative management, diabetes mellitus, glycoprotein IIb/IIIa inhibitors, heart failure, invasive strategy, lifestyle modification, myocardial infarction, nitrates, non-ST-elevation, P2Y 12 receptor inhibitor, percutaneous coronary intervention, renin-angiotensin-aldosterone inhibitors, secondary prevention, smoking cessation, statins, stent (...) extant CPG recommendations. Table 2. Associated CPGs and Statements Title Organization Publication Year/Reference CPGs Stable ischemic heart disease ACC/AHA/AATS/PCNA/SCAI/STS 2014 2012 Atrial fibrillation AHA/ACC/HRS 2014 Assessment of cardiovascular risk ACC/AHA 2013 Heart failure ACC/AHA 2013 Lifestyle management to reduce cardiovascular risk AHA/ACC 2013 Management of overweight and obesity in adults AHA/ACC/TOS 2013 ST-elevation myocardial infarction ACC/AHA 2013 Treatment of blood cholesterol

2014 American Heart Association

19. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: Executive Summary

with possible ACS and a normal ECG, normal cardiac troponins, and no history of coronary artery disease (CAD), it is reasonable to initially perform (without serial ECGs and troponins) coronary computed tomography angiography to assess coronary artery anatomy (Level of Evidence: A ) or rest myocardial perfusion imaging with a technetium-99m radiopharmaceutical to exclude myocardial ischemia. , (Level of Evidence: B ) It is reasonable to give low-risk patients who are referred for outpatient testing daily (...) therapy, beta blockers, biomarkers, calcium channel blockers, cardiac rehabilitation, conservative management, diabetes mellitus, glycoprotein Ilb/IIIa inhibitors, heart failure, invasive strategy, lifestyle modification, myocardial infarction, nitrates, non-ST-elevation, P2Y 12 receptor inhibitor, percutaneous coronary intervention, renin-angiotensin-aldosterone inhibitors, secondary prevention, smoking cessation, statins, stent, thienopyridines, troponins, unstable angina, and weight management

2014 American Heart Association

20. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

). It specifically addresses the role of coronary angiography for the diagnosis of CAD in patients with suspected SIHD. Coronary angiography for risk stratification has been addressed in Section 3.3 of the 2012 SIHD full-text guideline (4). Recommendations for use of coronary angiography in the following specific clinical circumstances have been addressed in other guidelines or statements and will not be discussed further here: • Patients with heart failure and/or reduced ejection fraction (13) • Patients who (...) have experienced sudden cardiac death or sustained ventricular arrhythmia (14) • Patients undergoing preoperative cardiovascular evaluation for noncardiac surgery (including solid organ transplantation) (15) • Evaluation of cardiac disease among patients who are kidney or liver transplantation candidates (16,17) Downloaded From: http://content.onlinejacc.org/ on 08/05/2014MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT Fihn, SD et al. 2014 Stable Ischemic Heart Disease Focused Update Page 10 Note that ACC

2014 Society for Cardiovascular Angiography and Interventions

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