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221. 2014 ESC Management of Antithrombotic Therapy in Atrial Fibrillation Patients Presenting With Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary or Valve Interventions

it might be premature to abandon aspirin after stent im- plantation in AF patients requiring OAC based solely on the results of WOEST, dual therapy with OAC and clopidogrel may be considered as an alternative to triple therapy in selected AF patients at low risk of stent thrombosis/recurrent cardiac events. Ongoingrandomizedcontrolledtrials andregistries Two randomized trials and one multinational registry are currently testing different antithrombotic combinations for patients on OAC therapy who (...) in non-valvular AF patients, 59 as well as data on patient outcomes from RCTs of NOACs and antiplatelets in ACS/PCI patients 60–64 (Table 2). Where a NOAC is used in combination with clopidogrel and/or low-dose aspirin, the lower tested dose for stroke prevention in AF (that is, dabi- gatran 110 mg b.i.d., rivaroxaban 15 mg o.d. or apixaban 2.5 mg b.i.d.) should be considered, to minimize the risks of bleeding. However, dabigatran 110 b.i.d. was one intervention arm of the RE-LY trial, and thus

2014 Heart Rhythm Society

222. 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

4.4.6. Care Objectives 51 4.5. Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS: Recommendations 52 4.5.1. Noninvasive Test Selection 53 4.5.2. Selection for Coronary Angiography 53 5. Myocardial Revascularization 54 5.1. Percutaneous Coronary Intervention 54 5.1.1. PCI—General Considerations: Recommendation 54 5.1.2. PCI—Antiplatelet and Anticoagulant Therapy 55 5.1.2.1. Oral and Intravenous Antiplatelet Agents: Recommendations 55 5.1.2.2. GP IIb/IIIa (...) Antiplatelet Therapy: Recommendations 61 6.2.2. Combined Oral Anticoagulant Therapy and Antiplatelet Therapy in Patients With NSTE-ACS 62 6.2.3. Platelet Function and Genetic Phenotype Testing 64 6.3. Risk Reduction Strategies for Secondary Prevention 64 6.3.1. Cardiac Rehabilitation and Physical Activity: Recommendation 65 6.3.2. Patient Education: Recommendations 65 6.3.3. Pneumococcal Pneumonia: Recommendation 65 6.3.4. NSAIDs: Recommendations 66 6.3.5. Hormone Therapy: Recommendation 67 6.3.6

2014 Society for Cardiovascular Angiography and Interventions

223. Atrial Fibrillation: Guidelines For Management of Patients With

. . e13 2.2.3.1. Atrial Tachycardia Remodeling e13 2.2.3.2. In?ammation and Oxidative Stress e13 2.2.3.3. The Renin-Angiotensin-Aldosterone System e13 2.2.3.4. Risk Factors and Associated Heart Disease e13 3.CLINICAL EVALUATION: RECOMMENDATION . ... e14 3.1. Basic Evaluation of the Patient With AF ... e14 3.1.1. Clinical History and Physical Examination . ... e14 3.1.2. Investigations ... e14 3.1.3. Rhythm Monitoring and Stress Testing ... e15 4.PREVENTION OF THROMBOEMBOLISM ... e15 4.1. Risk-Based (...) to develop, update, or revise written recommendations for clinical practice. Experts in the subject under consideration are selected from both organizations to examine subject- speci?c data and write guidelines. Writing committees are speci?cally charged to perform a literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected health outcomes where such data exist. Patient-speci?cmodi?ers, comorbidities, and issues

2014 American College of Cardiology

224. Stable Ischemic Heart Disease: Guideline For the Diagnosis and Management of Patients With

Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain: Recommendations e58 2.1.2. History e58 2.1.3. Physical Examination e60 2.1.4. Electrocardiography e60 2.1.4.1. RESTING ELECTROCARDIOGRAPHY TO ASSESS RISK: RECOMMENDATION e60 2.1.5. Differential Diagnosis e60 2.1.6. Developing the Probability Estimate e61 2.2. Noninvasive Testing for Diagnosis of IHD e62 2.2.1. Approach to the Selection of Diagnostic Tests to Diagnose SIHD e62 2.2.1.1. ASSESSINGDIAGNOSTICTESTCHARACTERISTICS e63 (...) 2.2.1.2. SAFETY AND OTHER CONSIDERATIONS POTENTIALLY AFFECTING TEST SELECTION e64 2.2.1.3. EXERCISEVERSUSPHARMACOLOGICALTESTING e65 2.2.1.4. CONCOMITANT DIAGNOSIS OF SIHD AND ASSESSMENT OF RISK e65 2.2.1.5. COST-EFFECTIVENESS e65 2.2.2. Stress Testing and Advanced Imaging for Initial Diagnosis in Patients With Suspected SIHD Who Require Noninvasive Testing: Recommendations e66 2.2.2.1. ABLE TO EXERCISE e66 2.2.2.2. UNABLE TO EXERCISE e66 2.2.2.3. OTHER e67 2.2.3. Diagnostic Accuracy of Nonimaging

2014 American College of Cardiology

225. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

several risk factors: age >1 month for full-term infants or 48 weeks’ postconceptional age for preterm infants, and absence of any previous apneic event at presentation to the hospital. Another large multicenter study found no association between the specific viral agent and risk of apnea in bronchiolitis. The literature on viral testing for bronchiolitis has expanded in recent years with the availability of sensitive polymerase chain reaction (PCR) assays. Large studies of infants hospitalized (...) for bronchiolitis have consistently found that 60% to 75% have positive test results for RSV, and have noted coinfections in up to one-third of infants. , , In the event an infant receiving monthly prophylaxis is hospitalized with bronchiolitis, testing should be performed to determine if RSV is the etiologic agent. If a breakthrough RSV infection is determined to be present based on antigen detection or other assay, monthly palivizumab prophylaxis should be discontinued because of the very low likelihood

2014 American Academy of Pediatrics

226. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (Full text)

With AF e210 3.1.1. Clinical History and Physical Examination e210 3.1.2. Investigations e210 3.1.3. Rhythm Monitoring and Stress Testing ………..e210 Prevention of Thromboembolism e211 4.1. Risk-Based Antithrombotic Therapy: Recommendations e211 4.1.1. Selecting an Antithrombotic Regimen—Balancing Risks and Benefits e212 4.1.1.1. Risk Stratification Schemes (CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED) e213 4.2. Antithrombotic Options e214 4.2.1. Antiplatelet Agents e214 4.2.2. Oral Anticoagulants e215 (...) of the evidence and acting as an independent group of authors to develop, update, or revise written recommendations for clinical practice. Experts in the subject under consideration are selected from both organizations to examine subject-specific data and write guidelines. Writing committees are specifically charged to perform a literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected health outcomes where such data exist

2014 American Heart Association PubMed abstract

227. Valvular Heart Disease: Guidelines For the Management of Patients With

Principles e63 2.1. Evaluation of the Patient With Suspected VHD e63 2.2. De?nitions of Severity of Valve Disease e64 2.3. Diagnosis and Follow-Up e64 2.3.1. Diagnostic Testing–Initial Diagnosis: Recommendation e64 2.3.2. Diagnostic TestingdChanging Signs or Symptoms: Recommendation e65 2.3.3. Diagnostic TestingdRoutine Follow-Up: Recommendation e65 2.3.4. Diagnostic TestingdCardiac Catheterization: Recommendation e65 2.3.5. Diagnostic TestingdExercise Testing: Recommendation e65 2.4. Basic Principles (...) 3.2.1.3. DIAGNOSTICTESTINGdROUTINEFOLLOW-UP .. e73 3.2.1.4. DIAGNOSTIC TESTINGdCARDIAC CATHETERIZATION e73 3.2.1.5. DIAGNOSTIC TESTINGdEXERCISE TESTING: RECOMMENDATIONS e74 3.2.2. Medical Therapy: Recommendations e74 3.2.3. Timing of Intervention: Recommendations e75 3.2.4. ChoiceofIntervention:Recommendation ...e79 4. Aortic Regurgitation e82 4.1. Acute AR e82 4.1.1. Diagnosis e83 4.1.2. Intervention e83 4.2. Stages of Chronic AR e83 4.3. Chronic AR e83 4.3.1. Diagnosis and Follow-Up e83 4.3.1.1

2014 American College of Cardiology

228. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary (Full text)

of evidence for or against particular tests, treatments, or procedures; and include estimates of expected health outcomes where such data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that may influence the choice of tests or therapies are considered, as well as frequency of follow-up and cost-effectiveness. When available, information from studies on cost is considered; however, review of data on efficacy and outcomes constitutes the primary basis for preparing

2014 American Heart Association PubMed abstract

229. Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (Full text)

bradycardia III/B ACE inhibitors, angiotensin receptor blockers, renin inhibitors Skeletal and cardiovascular abnormalities, renal dysgenesis, pulmonary hypoplasia III/C ACE indicates angiotensin-converting enzyme; and LFTs, liver function tests. Modified from Umans et al with permission from Elsevier, Copyright © 2009. α-Blockers, β-blockers, CCBs, hydralazine, and thiazide diuretics have been used in pregnancy; all transfer across the placenta. There are no data from large, well-controlled, randomized

2014 American Heart Association PubMed abstract

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

4.4.4. Early Invasive and Ischemia-Guided Strategies: Recommendations ... e168 4.4.4.1. Comparison of Early Versus Delayed Angiography ... . e169 4.4.5. Subgroups: Early Invasive Strategy Versus Ischemia-Guided Strategy ... ... e169 4.4.6. Care Objectives ... e169 4.5. Risk Strati?cation Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS: Recommendations . ... e170 4.5.1. Noninvasive Test Selection .. ... e170 4.5.2. Selection for Coronary Angiography.. ... e170 5.MYOCARDIAL (...) . ... e174 6.LATE HOSPITAL CARE, HOSPITAL DISCHARGE, AND POSTHOSPITAL DISCHARGE CARE . e175 6.1. General Principles (Cardioprotective Therapy and Symptom Management) ... e175 6.2. Medical Regimen and Use of Medications at Discharge: Recommendations .. e175 6.2.1. Late Hospital and Posthospital Oral Antiplatelet Therapy: Recommendations .. e175 6.2.2. Combined Oral Anticoagulant Therapy and Antiplatelet Therapy in Patients With NSTE-ACS . e177 6.2.3. Platelet Function and Genetic Phenotype Testing

2014 American College of Cardiology

231. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack (Full text)

ASCVD should be otherwise managed according to the ACC/AHA 2013 guidelines, which include lifestyle modification, dietary recommendations, and medication recommendations (Class I; Level of Evidence A ). 1. Revised to be consistent with the 2013 ACC/AHA cholesterol guideline Glucose disorders After a TIA or ischemic stroke, all patients should probably be screened for DM with testing of fasting plasma glucose, HbA 1c , or an oral glucose tolerance test. Choice of test and timing should be guided (...) by clinical judgment and recognition that acute illness may temporarily perturb measures of plasma glucose. In general, HbA 1c may be more accurate than other screening tests in the immediate postevent period (Class IIa; Level of Evidence C ). New recommendation Obesity All patients with TIA or stroke should be screened for obesity with measurement of BMI (Class I; Level of Evidence C ). New recommendation Given the demonstrated beneficial effects of weight loss on cardiovascular risk factors

2014 American Heart Association PubMed abstract

232. HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials (Full text)

of mortality was 0.40 (95% CI: 0.27–0.59). In the Multicenter Automatic Defibrillator Trial (MADIT), 196 patients with prior myocardial infarction, EF ≤0.35, and inducible nonsuppressible ventricular arrhythmias at electrophysiologic testing were randomized to receive an ICD or medical therapy alone. After an average follow-up of 27 months, the ICD was associated with a significant reduction in mortality (HR: 0.46; 95% CI: 0.26–0.82; P =.009). In the Multicenter Automatic Defibrillator Trial II (MADIT-II

2014 American Heart Association PubMed abstract

233. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes (Full text)

of Early Versus Delayed Angiography e370 4.4.5. Subgroups: Early Invasive Strategy Versus Ischemia-Guided Strategy e371 4.4.6. Care Objectives e371 4.5. Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS: Recommendations e371 4.5.1. Noninvasive Test Selection e371 4.5.2. Selection for Coronary Angiography e372 Myocardial Revascularization e372 5.1. Percutaneous Coronary Intervention e372 5.1.1. PCI–General Considerations: Recommendation e372 5.1.2. PCI (...) Management) e376 6.2. Medical Regimen and Use of Medications at Discharge: Recommendations e376 6.2.1. Late Hospital and Posthospital Oral Antiplatelet Therapy: Recommendations e376 6.2.2. Combined Oral Anticoagulant Therapy and Antiplatelet Therapy in Patients With NSTE-ACS e378 6.2.3. Platelet Function and Genetic Phenotype Testing e379 6.3. Risk Reduction Strategies for Secondary Prevention e379 6.3.1. Cardiac Rehabilitation and Physical Activity: Recommendation e379 6.3.2. Patient Education

2014 American Heart Association PubMed abstract

234. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: Executive Summary

regulatory or payer decisions, the intent is to improve the quality of care and be aligned with the patient’s best interest. Evidence Review —Guideline writing committee (GWC) members are charged with reviewing the literature; weighing the strength and quality of evidence for or against particular tests, treatments, or procedures; and estimating expected health outcomes when data exist. In analyzing the data and developing CPGs, the GWC uses evidence-based methodologies developed by the Task Force. A key (...) : postcardiac arrest care AHA 2010 Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure NHLBI 2003 Statements Key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes and coronary artery disease ACC/AHA 2013 Practical clinical considerations in the interpretation of troponin elevations ACC 2012 Testing of low-risk patients presenting to the emergency department

2014 American Heart Association

235. The International Society for Heart and Lung Transplantation Guidelines for the management of pediatric heart failure

with marked dyspnea on exertion IV Unable to carry out any physical activity because they typically have symptoms of HF at rest that worsens with any exertion Symptoms at rest such as tachypnea, retractions, grunting, or diaphoresis Expansions for the abbreviations used in Table 1 are provided in Appendix 3 . Genetic testing recommendations Chairs: Richard Kirk and Jeffery Towbin Dilated cardiomyopathy x 6 Ferlini, A., Neri, M., and Gualandi, F. The medical genetics of dystrophinopathies: molecular (...) relatives and may represent early disease. J Am Coll Cardiol . 1998 ; 31 : 195–201 | | | | | , x 9 Ackerman, M.J., Priori, S.G., Willems, S. et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). Heart Rhythm . 2011 ; 8 : 1308–1339 | | | | | , x 10 Mestroni, L. and Taylor, M.R.G. Genetics and genetic testing

2014 International Society for Heart and Lung Transplantation

236. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

. Document Review and Approval e62 1.4. Scope of the Guideline e62 2. General Principles e63 2.1. Evaluation of the Patient With Suspected VHD e63 2.2. De?nitions of Severity of Valve Disease e64 2.3. Diagnosis and Follow-Up e64 2.3.1. Diagnostic Testing–Initial Diagnosis: Recommendation e64 2.3.2. Diagnostic TestingdChanging Signs or Symptoms: Recommendation e65 2.3.3. Diagnostic TestingdRoutine Follow-Up: Recommendation e65 2.3.4. Diagnostic TestingdCardiac Catheterization: Recommendation e65 2.3.5 (...) . Diagnostic TestingdExercise Testing: Recommendation e65 2.4. Basic Principles of Medical Therapy e66 2.4.1. Secondary Prevention of Rheumatic Fever: Recommendation e66 2.4.2. IE Prophylaxis: Recommendations e67 2.5. Evaluation of Surgical and Interventional Risk e68 2.6. TheHeartValveTeamandHeartValveCenters of Excellence: Recommendations e69 3. Aortic Stenosis e71 3.1. Stages of Valvular AS e71 3.2. Aortic Stenosis e71 3.2.1. Diagnosis and Follow-Up e71 3.2.1.1. DIAGNOSTIC TESTINGdINITIAL DIAGNOSIS

2014 Society for Cardiovascular Angiography and Interventions

237. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) ? (3rd Edition)

. This may be done by assessing: • L V function o Clinical, chest X-ray, echocardiogram, radionuclide studies or cardiac MRI. • Presence of myocardial ischaemia o Clinical (recurrent angina). o Exercise stress testing in asymptomatic patients. - This may be done from day 5 post-STEMI (sub-maximal stress test with a target heart rate of 70% of maximum predicted heart rate) up to 6 weeks post-STEMI (maximal with a target heart rate of 90% of maximumpredicted heart rate for age or symptom limited (...) ). - If the pre-discharge sub-maximal stress test is negative, the patient should be subjected to a maximal or symptom limited stress test within 6 weeks after discharge. - For those who cannot exercise, consider dobutamine stress echocardiogram, radionuclide perfusion studies or cardiac MRI. • Presence of malignant ventricular arrhythmias. In the presence of angina, inducible ischaemia or late ventricular arrhythmia early coronary angiography with a view to revascularisation is indicated. 80 In patients

2014 Ministry of Health, Malaysia

238. Management of Heart Failure  (3rd Edition)

and fluid intake, regular exercise and appropriate lifestyle changes such as smoking cessation and abstinence from alcohol. • Performance measures should be instituted to assess quality of care.9 Figure 1 : Algorithm for the diagnosis of Heart Failure or LV dysfunction Suspected Heart Failure because of symptoms/sign Tests abnormal Tests abnormal Treat accordingly Determine : • Underlying cause • Severity • Precipitating Factors • Type of LV Dysfunction (systolic +/- diastolic) Heart Failure or LV (...) dysfunction unlikely. Consider other diagnosis such as: • coronary artery disease (angina equivalent) • pulmonary disease • obesity Additional diagnostic tests where approprate (eg: Coronary Angiography, Nuclear Imaging & CMR) Tests normal Echocardiography Test normal but clinical suspicion high ECG Chest Radiograph Natriuretic Peptides (where available) Test normal but clinical suspicion low10 Flowchart I : Management of Acute HF NOTE: * It is important to look for tissue hypoperfusion - cool peripheries

2014 Ministry of Health, Malaysia

239. Management of Chronic Kidney Disease (CKD) in Primary Care

will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every health care professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. These guidelines are not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic

2014 VA/DoD Clinical Practice Guidelines

240. Prevention of stroke in nonvalvular atrial fibrillation

) relative to that with warfarin (0.86%/y). Practice recommendation. C4. Clinicians might offer apixaban to patients with NVAF and GI bleeding risk who require anticoagulant medication (Level C). Other factors affecting administration of new oral anticoagulants. INR monitoring is not required for dabigatran, rivaroxaban, and apixaban for maintaining anticoagulation within the therapeutic window. Liberation from frequent periodic INR testing may be attractive to patients unwilling or unable to submit (...) to frequent periodic testing. Practice recommendation. C5. Clinicians should offer dabigatran, rivaroxaban, or apixaban to patients unwilling or unable to submit to frequent periodic testing of INR levels (Level B). Patients with NVAF who are at risk for stroke and unsuitable candidates for warfarin treatment are candidates for alternative treatment with aspirin, but the results are poor in view of the substantially lower level of protection conferred by aspirin (22% RRR) relative to that by warfarin (RRR

2014 American Academy of Neurology

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