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101. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

syndrome (ACS). Thus, among patients with CS within the appropriate demographic or with risk factors for coronary artery disease, ACS should be the focus of initial diagnostic testing, and this testing should include an ECG within 10 minutes of presentation. Although 5% to 12% of ACS cases are complicated by CS, this presentation is often associated with a large degree of at-risk myocardium. , In patients with a recent ACS, mechanical complications (including papillary muscle rupture, ventricular (...) . Thyroid disorders, both hyperthyroidism and hypothyroidism, can also cause circulatory collapse. , Pregnancy-associated cardiac conditions, including both peripartum cardiomyopathy and acute coronary dissection, may present as CS. Numerous additional causes of CS have been reported, but they typically occur in <1% of patients. , Laboratory Evaluation, Noninvasive Testing, and Hemodynamic Monitoring Laboratory Evaluation Biomarkers of cardiac myonecrosis are useful to gauge the severity of acute

2017 American Heart Association

102. Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

adversity may increase the risk of cardiometabolic (and other) diseases: behavioral, mental health, and biological. Behavioral Factors Evidence suggests that childhood adversity is associated with adverse health behaviors that increase the risk of cardiometabolic disease, including smoking, overeating, consumption of energy-dense foods, and inactivity. , , The association of childhood adversity with these behaviors was first tested by Felitti et al. In their retrospective ACE study, Felitti et al (...) childbirth would also capture intergenerational adversity and perinatal programming. Limited Identification of Mechanisms As discussed, childhood adversity may provoke unhealthy behaviors and poor mental health or produce neurobiological alterations that initiate relevant pathophysiological processes. Few studies have explicitly tested the mechanisms linking childhood adversity and cardiometabolic disease with comprehensive mediation models. Moreover, no study of which we are aware has tested a range

2017 American Heart Association

103. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non?ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures Full Text available with Trip Pro

Short Title: PM-15: Stress Test in Conservatively Treated Patients 27 Short Title: PM-16: Early Troponin Measurement After NSTEMI 28 Short Title: PM-17: AMI Registry Participation 28 Quality Improvement Measures for Inpatient STEMI and NSTEMI Patients 29 Inpatient Measures 29 Short Title: QM-1: Risk Score Stratification for NSTEMI 29 Short Title: QM-2: Early Invasive Strategy for High-Risk NSTEMI 30 Short Title: QM-3: Therapeutic Hypothermia for STEMI Patients 31 Short Title: QM-4: Aldosterone (...) to have the measure tested to identify the consequences of measure implementation. Quality measures may then be promoted to the status of performance measures as supporting evidence becomes available. Gregg C. Fonarow, MD, FACC, FAHA Chair, ACC/AHA Task Force on Performance Measures 1. Introduction In the summer of 2015, the Task Force convened the writing committee to begin the process of revising the existing set of performance measures for adult patients hospitalized with ST-Elevation and Non–ST

2017 American Heart Association

104. High Blood Pressure in Adults: Guideline For the Prevention, Detection, Evaluation and Management

. Laboratory Tests and Other Diagnostic Procedures.. . e159 7.2. Cardiovascular Target Organ Damage . . e159 Whelton et al. JACC VOL. 71, NO. 19, 2018 2017 High Blood Pressure Clinical Practice Guideline MAY 15, 2018:e127–248 e1288.TREATMENT OF HIGH BP . e160 8.1. Pharmacological Treatment ... e160 8.1.1. InitiationofPharmacologicalBPTreatment in the Context of Overall CVD Risk .. .. e160 8.1.2. BP Treatment Threshold and the Use of CVD Risk Estimation to Guide Drug Treatment of Hypertension .. .. e160 (...) include methodologists, epidemiolo- gists, healthcare providers, and biostatisticians. The recommendations developed by the writing committee on the basis of the systematic review are marked with “SR”. Guideline-Directed Management and Therapy The term guideline-directed management and therapy (GDMT) encompasses clinical evaluation, diagnostic testing, and pharmacological and procedural treatments. For these and all recommended drug treatment regi- mens, the reader should con?rmthedosagebyreview- ing

2017 American College of Cardiology

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

VHD guideline). Outcomes after surgical AVR are excellent in patients who do not have a high procedural risk (43–46,48). Surgical series demonstrate improved symptoms after AVR, and most patients have an improvement in exercise tolerance, as documented in studies with pre- and post-AVR exercise stress testing (43–46,48). The choice of prosthetic valve type is discussed in Section 11.1 of this focused update. IA Surgical AVR or TAVR is recommended for symptomatic patients with severe AS (Stage D

2017 American College of Cardiology

107. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of Amer

and potential off-target effects may be complex with inhibition of the neprilysin enzyme, which has multiple biological targets. Use of an ARNI is associated with hypotension and a low-frequency incidence of angioedema. To facilitate initiation and titration, the approved ARNI is available in 3 doses that include a dose that was not tested in the HF trial; the target dose used in the trial was 97/103 mg twice daily. 147 Clinical experience will provide further information about the optimal titration (...) with NYHA class II–IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm. 203 NEW: New data demonstrate a signal of harm when adaptive servo-ventilation is used for central sleep apnea. See Online Data Supplement G. Mortality rate (all cause and cardiovascular) was higher with adaptive servo-ventilation plus GDMT than with GDMT alone in a single RCT to test the addition of adaptive servo-ventilation (=5 hours/night, 7 days/week) to GDMT in patients with HFrEF and central sleep apnea

2017 American Heart Association

108. 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

treatment for AIS patients re- ceiving NOACs must balance the anticoagulant effect of these agents and the ICH risk associated with reperfusion strategies. As has been mentioned previously, routinely performed blood coagulation studies do not reliably ex- clude a significant plasma concentration of the NOACs. Another difficulty in a time-sensitive setting is that the more sensitive blood tests are either not routinely avail- able or have an unacceptably long delay to results. In experimental studies (...) study 76 comprised 78 NOAC-treated patients undergoing intravenous throm- bolysis or intra-arterial therapy a median of 13 hours after the last NOAC dose compared with 441 warfarin- treated patients and 8938 on no anticoagulants. After propensity score matching, there was no significant dif- ference in rate of any ICH, symptomatic ICH, or death among the groups. In the absence of immediately avail- able blood tests sensitive to the presence of NOACs, determining which patients taking these agents

2017 American Heart Association

109. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Guideline For the Management of Patients With

OR SUSPECTEDVA ... .. e105 4.1. History and Physical Examination ... . e105 4.2. Noninvasive Evaluation . e106 4.2.1. 12-lead ECG and Exercise Testing .. e106 4.2.2. Ambulatory Electrocardiography .. e107 4.2.3. Implanted Cardiac Monitors . .. e108 4.2.4. Noninvasive Cardiac Imaging .. e108 4.2.5. Biomarkers . .. e109 4.2.6. Genetic Considerations in Arrhythmia Syndromes . .. e109 4.3. Invasive Testing . e110 4.3.1. Invasive Cardiac Imaging: Cardiac Catheterization or CT Angiography .. .. e110 4.3.2 (...) The term guideline-directed management and therapy (GDMT) encompasses clinical evaluation, diagnostic testing,andpharmacologicalandproceduraltreatments. For these and all recommended medication treatment regimens, the reader should con?rm the dosage by reviewing product insert material and evaluate the treat- ment regimen for contraindications and interactions. The recommendationsarelimitedtomedications,devices,and treatments approved forclinical use in the United States. Class of Recommendation

2017 American College of Cardiology

110. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. Results: A number of biomarkers associated with HF are well recognized, and measuring (...) peptide testing for the evaluation of patients with suspected or proven heart failure (HF) in the year 2000, interest in biomarkers has grown exponentially. Accordingly, a large number of preclinical and clinical analyses of biomarkers in HF have been completed, and the volume of publications in peer-reviewed literature focused on HF biomarkers has risen dramatically. In addition, after the regulatory approval of the natriuretic peptides for clinical use, a number of newer biomarkers have received

2017 American Heart Association

111. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

, the adjusted odds for incident peripheral arterial disease were 1.67 times higher in African Americans compared with whites. The San Diego Population Study included markers of inflammation in multivariable models to test whether they explained the residual excess risk in African Americans compared with whites but found that, although the RRs for peripheral artery disease between African Americans and whites were further attenuated, they remained statistically significantly higher, ranging from 1.5 to 2.0 (...) duration appears to be a consistent risk factor for stroke, early indications suggest that among diabetic adults, short sleep duration (≤6 hours) is associated with increased stroke risk in whites (OR, 1.38; 95% CI, 1.06–1.80) but not in African Americans (OR, 0.86; 95% CI, 0.58–1.26). Additional research is needed to test the association of objectively determined sleep duration with incident CHD risk in African Americans compared with whites. Summary There are significant disparities in the age

2017 American Heart Association

112. Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults With Cardiovascular Disease

more significantly in older age. Oxygen use is ideally measured by cardiopulmonary exercise testing (CPET). Peak V o 2 is an assessment of maximal aerobic performance that implies that activity has intensified to a point of maximal volition; hence, peak V o 2 is usually assessed as part of a symptom-limited or maximum exercise test. Metabolic equivalents (METs) achieved are a surrogate indicator of exercise performance that are calculated from workload (ie, treadmill speed/grade or Watts) and often (...) et al used the METs calculated from standard ETT and showed that even this relatively less intricate measure of CRF was a powerful predictor of mortality in adults with coronary heart disease and in adults without CVD. In multiple studies, CRF metrics, whether measured by CPET, ETT, or 6-minute walking testing (6MWT), have shown significant prognostic bearing for patients with coronary artery disease (CAD), valvular heart disease, arrhythmia, peripheral arterial diseases, pulmonary hypertension

2017 American Heart Association

113. Dietary Fats and Cardiovascular Disease Full Text available with Trip Pro

, polyunsaturated fat or carbohydrates, differed among trials. Reviewers who evaluate these trials must take into account the specific nutritional experiment that was conducted and the level of its adherence throughout the follow-up period. Low Saturated, High Polyunsaturated Fat Diets In the mid-1950s, 4 research groups reported that replacing saturated fat from animal products with polyunsaturated fat from vegetable oils substantially reduced serum cholesterol levels. Soon, controlled trials followed to test (...) % to 70% of the full effect. , Trials of serum cholesterol–lowering agents show that a reduction in coronary heart disease (CHD) incidence occurs with a lag of 1 to 2 years. These systematic reviews , , together found and analyzed 6 additional trials , , that replaced saturated with polyunsaturated fat but did not have ≥1 of these characteristics crucial to testing the hypothesis. We also discuss these “noncore” trials and evaluate their potential impact on the overall result on dietary saturated

2017 American Heart Association

114. 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

not have a high procedural risk. 43–46,48 Surgical series demonstrate improved symptoms after AVR, and most patients have an improvement in exercise tolerance, as documented in studies with pre- and post-AVR exercise stress testing. 43–46,48 The choice of prosthetic valve type is discussed in Section 11.1 of this focused update. I A Surgical AVR or TAVR is recommended for symptomatic patients with severe AS (Stage D) and high risk for surgical AVR, depending on patient-specific procedural risks, values

2017 American Heart Association

115. 2017 Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: A Joint Consensus Document from EHRA and ESC Working Group on Thrombosis

(or procedure), and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered, as are frequency of follow-up and cost effectiveness. In controversial areas, or with regard to issues without evidence other than usual clinical practice, a consensus was achieved by agreement of the expert panel after thorough deliberations. This document was prepared

2017 Heart Rhythm Society

116. Imaging Program Guidelines: Pediatric Imaging

Bryn Mawr Avenue South Tower – Suite 800 Chicago, IL 60631 P . 773.864.4600 www.aimspecialtyhealth.comTable of Contents – Pediatrics | Copyright © 2017. AIM Specialty Health. All Rights Reserved. 2 Table of Contents Description and Application of the Guidelines 4 Administrative Guidelines 5 Ordering of Multiple Studies 5 Pre-test Requirements 6 Head & Neck Imaging 7 CT of the Head – Pediatrics 7 MRI of the Head/Brain – Pediatrics 14 CTA/MRA Head: Cerebrovascular – Pediatrics 21 Functional MRI (fMRI (...) of clinical appropriateness under the guidelines for specific imaging exams is a determination that the following are true with respect to the imaging request: ? A clinical evaluation has been performed prior to the imaging request (which should include a complete history and physical exam and review of results from relevant laboratory studies, prior imaging and supplementary testing) to identify suspected or established diseases or conditions. ? For suspected diseases or conditions: ? Based

2017 AIM Specialty Health

117. AIM Clinical Appropriateness Guidelines for Joint Surgery

program resulting in abstinence from tobacco for at least six (6) weeks prior to surgery is recommended. Documentation of nicotine-free status by laboratory testing (e.g., cotinine level or carboxyhemoglobin) is recommended. After six (6) weeks of tobacco cessation, labs should be performed with ample time afforded to submit this confirmation and complete the prior authorization process. Diabetes – It is recommended that a patient with history of diabetes maintain hemoglobin A1C 8% or less prior (...) activities. Copyright © 2017. AIM Specialty Health. All Rights Reserved. Joint Surgery 11 Indications and Criteria Rotator Cuff Repair Note: For primary rotator cuff repair, adherence to a tobacco-cessation program resulting in abstinence from tobacco for at least six (6) weeks prior to surgery is recommended. Documentation of nicotine-free status by laboratory testing (e.g., cotinine level or carboxyhemoglobin) is recommended. After six (6) weeks of tobacco cessation, labs should be performed with ample

2017 AIM Specialty Health

118. Heart Failure (Focused Update): Guideline For the Management of

in asingle RCT to test the additionofadaptiveservo-ventilation($5hours/night,7days/week)toGDMTinpatientswithHFrEFandcentralsleepapnea(203).Asimilarriskhas been seen in another trial, and a third trial of adaptive servo-ventilation in central sleep apnea and HF was aborted because of ethical concerns. The weight of evidence does not support the use of adaptive servo-ventilation for central sleep apnea in HFrEF. Yancy et al. JACC VOL. 70, NO. 6, 2017 2017 ACC/AHA/HFSA Heart Failure Focused Update AUGUST 8 (...) with suspected heart failure: results of the UK natriuretic peptide study. Eur J Heart Fail. 2005;7:537–41. 18. Son CS, Kim YN, Kim HS, et al. Decision-making model for early diagnosis of congestive heart failure usingroughsetanddecisiontreeapproaches.JBiomed Inform. 2012;45:999–1008. 19. KelderJC,CramerMJ,VanWJ,etal.Thediagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Circulation. 2011;124:2865–73. 20. Balion C, Don-Wauchope A, Hill S, et

2017 American College of Cardiology

120. The Canadian Cardiovascular Society heart failure companion: bridging guidelines to your practice

should includenumericEF or smallrange of EF and diastolic function evaluation Following titration of triple therapy for HFrEF, or consideration of ICD/CRT implantation 3 Months after completion of titration ECHO or MUGA or CMRI (preferably the same modality and laboratory test as initial test) LVEF after medical therapy might increase, obviating device therapy Stable HF Approximately every 2-3 years, especially if EF is> 40% ECHO or MUGA or CMRI Rationale is to identify improving (better prognosis (...) . 25. Zannad F, McMurray JJ, Drexler H, et al. Rationale and design of the EplerenoneinMildPatientsHospitalizationAndSurvIvalStudyinHeart Failure (EMPHASIS-HF). Eur J Heart Fail 2010;12:617-22. 26. Young JB, Dunlap ME, Pfeffer MA, et al. Mortality and morbidity reduction with candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials. Circulation 2004;110: 2618-26. 308 Canadian Journal

2016 CPG Infobase

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