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McMurray Test

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101. 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter

-for-performance programs (ie, contexts in which performance measures are used). New measures are initially evaluated for potential inclusion as performance measures. In some cases, a measure is insufficiently supported by the guidelines. In other instances, when the guidelines support a measure, the writing committee may decide it is necessary to have the measure tested to identify the consequences of measure implementation. Quality measures may then be promoted to the status of performance measures (...) . The writing committee acknowledges that the new measures created in this set will need to be tested and validated over time. By publishing this clinical performance and quality measure set, the writing committee encourages adoption of these performance and quality measures, which will help to facilitate the collection and analysis of data needed to assess the validity of these measures. In the future, the writing committee anticipates having data that will allow them to reassess whether any

2016 American Heart Association

102. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

annotation (E) including genetic defect or underlying disease/sub- strate, and the functional status (S) of the disease using both the ACC/AHA HF stages and New York Heart As- sociation (NYHA) functional class. This nomenclature is endorsed by the World Heart Federation, is supported by an Internet-assisted application, and assists in the de- scription of cardiomyopathy in symptomatic or asymp- tomatic patients and family members in the context of genetic testing. 8,9 Classifications of cardiomyopathies (...) complexes with inverted T waves can also be present. 179 Diagnosis To confirm the diagnosis of PPCM, a full history, physical examination, and diagnostic testing should be completed to exclude a previous history of heart disease and other causes of cardiomyopathy. For the classic definition of PPCM, the history should confirm that the onset of HF began in the last months of pregnancy or the months after delivery, and cardiac evaluation should confirm the presence of LV dysfunction. 158,189 Usual HF

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2016 American Heart Association

103. Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

impact of telemonitoring on heart failure–related rehospitalization rates or on mortality. The BEAT-HF (Better Effectiveness After Transition–Heart Failure) randomized trial tested telemonitoring with electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight with centralized registered nurses conducting telemonitoring reviews, protocol-driven actions, and telephone calls for patients hospitalized with heart failure. The intervention had no impact (...) and treatment of hypertension. In the past, Holter monitors, stress tests, and office-based electrocardiography studies were used to evaluate patients with suspected arrhythmias. In an era when every smartphone will be able to have an FDA-approved electrocardiography device built into the protective case or the wrist strap of a smartwatch, the role of this legacy equipment will evolve. As patients experience symptoms, they can touch their phone and capture a single-lead ECG, and it can be sent

2016 American Heart Association

104. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

responsiveness testing. This testing incorporates vibratory, audible, and visual alerts. If the patient presses a response button, the episode is aborted. If no patient response is recorded, the defibrillation electrodes discharge gel onto the skin and ultimately deliver a shock via an apex-posterior vector. Depending on the type of arrhythmia (VT or VF) and the device programming, the overall response time (detection to shock) can take between 25 and 60 seconds. WCD shock energies range between 75 and 150 J (...) and adolescents. Use of the WCD is approved by the FDA in selected patients at risk for sudden cardiac arrest. However, there are several important relative contraindications. Patients with unipolar pacing (atrial or ventricular) cannot use a WCD because the large-amplitude pacing stimuli can interfere with arrhythmia detection. Additionally, patients who cannot detect or respond to patient responsiveness testing stimuli are not appropriate candidates for the WCD. Beyond the contraindications to WCD therapy

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2016 American Heart Association

105. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An 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 Clinic

trials. 10 This ARNI has recently been approved for patients with symptomatic HFrEF and is intended to be substituted for ACE inhibitors or ARBs. HF effects 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 (...) . 1995;333:1670–6 . 15 . Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators . A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure . N Engl J Med . 2001;345:1667–75 . Downloaded from http://ahajournals.org by on March 27, 2019Heart Failure Focused Update on Pharmacological Therapy CLINICAL St AteMeNtS ANd GuIdeLINeS Circulation. 2016;134:e282–e293. DOI: 10.1161/CIR.0000000000000435 September 27, 2016 e289 16 . Pfeffer MA, McMurray JJV, Velazquez EJ, et al

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2016 American Heart Association

106. Transplantation and Mechanical Circulatory Support in Congenital Heart Disease

a propensity score–weighted hazard ratio of 3.25 impact on mortality Troponin In CHD with PH, troponin, NT-proBNP, and RV function were determinants of death BNP/NT-proBNP Associated with poor outcomes and increased mortality in ACHD, ES Exercise testing 6-Min walk distance in ES predicts mortality Peak systolic blood pressure during exercise <180 mm Hg and increased RV end-diastolic volume index (>150 mL/m 2 ) is associated with increased risk in systemic RV (death, vascular events, tricuspid (...) of Fallot; , minute ventilation/carbon dioxide production; and VT, ventricular tachycardia. As in acquired HF, exercise testing including formal cardiopulmonary testing can provide prognostic information in ACHD. In the most comprehensive cardiopulmonary exercise study to date (1375 consecutive patients, with a mean follow-up of 5.8 years), after adjustment for clinical parameters, a combination of peak and heart rate reserve provided the greatest predictive power across a broad range of CHD diagnoses

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2016 American Heart Association

108. Knowledge Gaps in Cardiovascular Care of the Older Adult Population

domains beyond chronological age, such as frailty and cognitive function, and the incorporation of patient preferences into shared decision making have not been assessed adequately. The utility of all cardiac preventative measures, diagnostic tests, and therapeutic interventions, including medications, invasive procedures, and other programs (eg, cardiac rehabilitation) in the management of older patients with CVD warrants careful scrutiny, especially in the context of multimorbidity, polypharmacy (...) adults have a high prevalence of 3-vessel and left main disease and that ischemic heart disease (IHD) is a prominent source of morbidity and mortality. The guideline highlights the limitations of exercise stress testing in older patients and endorses pharmacological testing as a more useful option for diagnosis and prognosis in many older patients. The guideline acknowledges that although there is strong rationale to treat IHD in older adults, there are limited data pertaining to older patients

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2016 American Heart Association

109. Acute Myocardial Infarction in Women

. , Cigarette smoking is a major risk factor for CAS, and possible triggers include variation in autonomic activity, cocaine use, ephedrine alkaloids, and other drugs. , Provocative testing with ergonovine, acetylcholine, or hyperventilation during coronary angiography can be helpful in diagnosing CAS. Data on sex differences associated with CAS are limited. One study demonstrated that women with CAS were typically older, had a lower incidence of smoking, and had less significant obstructive CHD compared (...) with atherosclerosis regression. CAS plays a significant role in the development of an AMI via thrombin generation resulting in thrombus formation and impaired fibrinolytic activity resulting in thrombus preservation. In patients with ACS from the Coronary Artery Spasm in Patients With Acute Coronary Syndrome (CASPAR) study, ≈25% had no obstructive culprit lesion on coronary angiography. CAS was present in almost 50% of the patients who underwent acetylcholine provocative testing. Provoked CAS is an independent

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2016 American Heart Association

110. Knee Surgery

, and nature of pain, including how it may manifest during sleep, and presence of any instability, locking, or problems with mobility and weight bearing are all important to assess. Clinical examination typically assesses and documents: range of motion, effusion, crepitus, tenderness, stability, and provocative tests e.g. McMurray’s, patellar apprehension, Apley’s, and Lachman’s tests. Clinically meaningful improvement in function is an improvement in pain and function of 30% over baseline [14] . This can (...) realignment procedure with or without lateral retinacular release Patellar dislocation History of acute traumatic dislocation Lateral tracking of the patella OR Recurrent effusion OR Positive patellar apprehension test OR Synovitis with or without crepitus OR Recurrent dislocations MRI (not x-ray or CT scan) shows: Medial Patellofemoral Ligament (MPFL) disruption OR Osseous contusion OR Cartilage injury 6 weeks of physical therapy is required for first time dislocation; physical therapy is not required

2016 Washington State Department of Labor and Industries

111. Cardiac Resynchronization Therapy in Heart Failure

Minnesota Living with Heart Failure Questionnaire MUHC McGill University Health Centre NICE National Institutes for Health and Clinical Excellence NYHA New York Heart Association OPT Optimal pharmacologic therapy QALY Quality adjusted life-year QOL Quality of life RCT Randomized controlled trial RR Risk ratio TAU MUHC Technology Assessment Unit 6-MWT 6-minute walk test CRT for heart failure xiv February 22, 2016 Technology Assessment Unit, MUHC EXECUTIVE SUMMARY BACKGROUND Since the first review

2016 McGill TAU reports

112. Heart Failure - Systolic Dysfunction

, tadalafil, and vardenafil. Ivabradine Initiation: For patients with persistent symptoms and HR > 70 despite maximally tolerated or target dose beta blocker Contraindication: Atrial fibrillation Diuretics "Background" therapy. Though not specifically tested in clinical trials, diuretics should still be used as needed for volume overload. Diuretics were consistently part of background therapy in all published placebo controlled mortality trials of symptomatic patients in which ACE inhibitors, beta (...) blockers, and aldosterone antagonists were tested. Combining Drugs Starting other drugs. The therapy described in Table 2 is the desired endpoint for patients with the indicated symptoms and history. No data are available to indicate how best to introduce all of these medications. All of the major trials added beta blockers or spironolactone to background therapy of ACE inhibitors, diuretics, and sometimes digoxin. Electrolytes and renal function. Many of the medications appropriate for HF (ACE, ARB

2016 University of Michigan Health System

113. Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

all portend a poor prognosis. Submaximal exercise testing also predicts mortality in ambulatory patients with HF. Additionally, cognitive impairment is a predictor of mortality in HF and may affect self-care ability. Social environmental factors such as income, disability status, Medicaid insurance, unmarried status, living alone or at a distance from hospital care, and history of alcohol or drug abuse are independent predictors of poor outcomes, including survival in advanced HF. In the REMATCH (...) in the disease course. The early elicitation of patient preferences may be especially important in the CVD population, considering the numerous options for diagnostic testing and advanced therapies even in end-stage disease. Although the direct impact of hospice care on caregiver QOL remains uncertain, a relationship between caregivers’ QOL and their estimate of the patients’ QOL was shown when cancer patients received hospice services. , Limited and conflicting evidence supports the ability of palliative

2016 American Heart Association

114. Chronic Heart Failure in Congenital Heart Disease

evidence that categorizing patients with CHD by this system enables management decisions or improves outcome. However, portions of the guidelines should apply to patients with CHD. The guidelines are clear that HF is a clinical diagnosis and that the presence of ventricular dysfunction or the result of any other single diagnostic test is not sufficient to make the diagnosis. This definition of HF as a clinical diagnosis not based solely on a diagnostic test also applies to patients with CHD (...) between NYHA class based on subjective description of symptoms and exercise capacity on cardiopulmonary exercise testing has been described. Children may be unaware of any limitation. Therefore, objective assessment of exercise capacity is advocated for all patients with CHD, particularly those for whom management may be changed by results or who would benefit from understanding objective limitations to exercise. Patients with an objective reduction in exercise tolerance should be considered

2016 American Heart Association

115. Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition

, PhD Candidate Associate Professor Laurentian University Sudbury, Ontario Jessica Po Ying Lok, RN, BScN, MN Clinical Educator, Nursing and Personal Support VHA Home HealthCare Toronto, Ontario Shirley Marr, RN, BScN, MHEd, MHScN, CNCC(C) Clinical Nurse Educator, ICU William Osler Health System Toronto, Ontario Leah Masin, RN Staff Nurse Southlake Regional Health Center Newmarket, Ontario Elizabeth McMurray, RN, BScN Professional Practice Consultant Lead for a review group from St. Joseph’s Health

2016 Registered Nurses' Association of Ontario

116. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

prospective or case-controlled trials; MRI = magnetic resonance imaging; MUFA = monoun- saturated fatty acid; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; NES = night eating syndrome; NHANES = National Health and Nutrition Examination Surveys; NHLBI = National Heart, Lung, and Blood Institute; NHS = Nurses’ Health Study; NICE = National Institute for Health and Care Excellence; OA = osteoarthritis; OGTT = oral glucose tolerance test; OR = odds ratio; OSA = obstructive

2016 American Association of Clinical Endocrinologists

117. Anticoagulation - oral

the management of people receiving apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin treatment in primary care, including brief advice about the place of self-testing and self-management of warfarin. This CKS topic does not cover the management of acenocoumarol or phenindione and does not cover secondary care management. There are separate CKS topics on , , , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact (...) products Regulatory Agency (MHRA) Public assessment report. Warfarin: changes to product safety information. December 2009 — minor update. Advice about taking antidepressants in people receiving warfarin has been amended in the section on Drug interactions. Issued in December 2009. August to September 2009 — updated to include recommendations and supporting evidence on the place of self-testing and self-management of warfarin. Advice on the management of the drug interaction between selective serotonin

2019 NICE Clinical Knowledge Summaries

118. Heart failure - chronic

and transthoracic echocardiography within 2 weeks. Refer people with suspected heart failure and an NT‑proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) to have specialist assessment and transthoracic echocardiography within 6 weeks. In all people: A 12-lead ECG should be arranged in addition to considering other tests to exclude possible aggravating factors or other conditions. A loop diuretic may be prescribed for symptom relief while awaiting specialist assessment. For people with confirmed (...) is less than 400 pg/mL (47 pmol/L), be aware that a diagnosis of heart failure is less likely. Consider discussion with a physician with subspeciality training in heart failure if a clinical suspicion of heart failure persists. Be aware that the level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. Arrange a 12-lead ECG in all people. Consider other tests to evaluate for possible aggravating

2019 NICE Clinical Knowledge Summaries

119. Atrial fibrillation

peptide during episodes of AF [ ]. Differential diagnosis The information on the differential diagnoses an irregular pulse is based on expert opinion in the BMJ Best Practice guidelines Chronic Atrial Fibrillation [ ] and New Onset Atrial Fibrillation [ ], the American College of Cardiology Foundation/American Heart Association/European Society of Cardiology Guidelines for the management of patients with atrial fibrillation [ ] and a medical textbook on AF [ ]. Diagnostic tests (ECG (...) ) The recommendations on diagnostic tests for atrial fibrillation are based largely on expert opinion in the National Institute for Health and Care Excellence (NICE) guideline: Atrial fibrillation: the management of atrial fibrillation [ ]. NICE makes no specific recommendations on ECG interpretation. The information on the features of an ECG that are confirmatory for atrial fibrillation is therefore based on expert opinion in a medical textbook [ ] and in the BMJ Best Practice guideline Chronic Atrial Fibrillation

2019 NICE Clinical Knowledge Summaries

120. Do Intravenous Nitrates Improve Dyspnea in Acute Heart Failure Syndromes More Than Alternative Pharmacologic Interventions?

. McMurray JJ, Adamopoulos S, Anker SD, et al; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787-1847. 5. YancyCW,JessupM,BozkurtB,etal;American CollegeofCardiology Foundation;American (...) and diagnosis, in 18 categories. Go to the Images pull-down menu and test your diagnostic skill today. Below is a selection from the Dermatology Images. “Woman With Painful Swellingin Fingers” by Habboushe and Newman,May 2011,Volume57,#5,pp.434,441. Systematic Review Snapshot Volume 66, no. 1 : July 2015 Annals of Emergency Medicine 29

2015 Annals of Emergency Medicine Systematic Review Snapshots

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