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121. 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

122. 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

123. 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

124. 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

125. 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

126. 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

127. 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

128. 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

129. 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

131. 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

132. 2016 Focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation

), or in the situation in which it has not stabilized the patient, idarucizumab should be administered as soon as possible. Although dilute thrombin time and ecarin clotting time were used to identify the presence of dabigatran in REVERSE-AD, these tests are not widely available. Thrombin time and activated partial thromboplastin time are widely available and can qualitatively identify the presence of active dabigatran in a patient, 65 however, obtaining these tests (...) Open 2012;2. 22. Dentali F, Riva N, Crowther M, et al. Ef?cacy and safety of the novel oral anticoagulants in atrial ?brillation: a systematic review and meta- analysis of the literature. Circulation 2012;126:2381-91. 23. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial ?brillation. N Engl J Med 2011;365: 981-92. 24. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial ?brillation. N Engl J Med 2011;365:883-91. 25

2016 CPG Infobase

133. Management of chronic heart failure

pressure Peripheral oedema (ankle, sacral, scrotal) Hepatojugular reflux Pulmonary crepitations Third heart sound (gallop rhythm) Reduced air entry and dullness to percussion at lung bases (pleural effusion) Laterally displaced apical impulse Tachycardia Cardiac murmur Irregular pulse Tachypnoea (>16 breaths/min) Hepatomegaly Ascites Tissue wasting (cachexia) Reproduced from McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment (...) are most useful rather than any of these in isolation. Basic early investigations are necessary to differentiate heart failure from other conditions and to provide prognostic information. Urinalysis, serum urea and creatinine tests may help to determine if there is kidney failure, since symptoms of kidney disease are similar to those of HF . Chest X-ray may indicate signs of HF such as cardiomegaly, pulmonary congestion or pleural effusion and also non-cardiac indications such as lung tumours which

2016 SIGN

134. Acute coronary syndrome

coronary intervention 20 6 Risk stratification and non-invasive testing 22 6.1 Risk stratification 22 6.2 Assessment of cardiac function 22 6.3 Stress testing 23 7 Invasive investigation and revascularisation 24 7.1 Invasive investigation 24 7.2 Access routes for percutaneous coronary intervention 25 7.3 Glycoprotein IIb/IIIa receptor antagonists 26 7.4 Coronary artery bypass grafting surgery 26 8 Early pharmacological intervention 28 8.1 Antiplatelet therapy 28 8.2 Anticoagulant therapy 29 8.3 Statin (...) to be admitted to hospital for serial testing. Use of a high-sensitivity cardiac troponin assay permits the use of lower diagnostic thresholds than standard troponin assays, and allows earlier testing that may reduce unnecessary hospital admissions, waiting times for test results and associated anxiety in patients and carers. 37 Early rule-out protocols typically involve serial cardiac troponin measurements on presentation and three hours later. 38 High-sensitivity cardiac troponin assays appear to improve

2016 SIGN

135. The 2014 Canadian Cardiovascular Society heart failure management guidelines focus update: anemia, biomarkers, and recent therapeutic trial implications

with chronic stable heart failure should undergo natriuretic peptide testing. Third, considerations should be given to treat selected patients with heart failure and preserved sys- tolic function with a mineralocorticoid receptor antagonist and to treat patients with heart failure and reduced ejection fraction with an angiotensin receptor/neprilysin inhibitor, when the drug is approved. As with updates in previous years, the topics were chosen in response to stakeholder feedback. The 2014 Update includes (...) Furthermore, RCTs in patients with acute dyspnea have demonstrated that NP testing when used with conventional managementissuperiortoconventionalmanagement alonein improving clinical outcomes and reducing cost. 47,48 However, the role of biomarkers including NP in the management of patientswithacutecardiovascularsymptomsintheambulance before arrival at the hospital is still unclear. 49 Importantly, the optimal strategy to fully incorporate these research data

2015 CPG Infobase

136. Chronic Heart Failure - Diagnosis and Management

years with chronic heart failure (HF) in the primary care setting. Key Recommendations B-Type natriuretic peptide (BNP) OR N-terminal prohormone of BNP (NT-proBNP) is the biochemical test of choice for ruling-in or ruling-out the diagnosis of HF and should be considered as part of the initial evaluation of patients with dyspnea suspected of having HF. [Amended, 2015] BNP (or NT-proBNP) testing should not be used routinely for monitoring disease severity. [New, 2015] Educate the patient and family (...) in heart failure. 2012. The Criteria Committee of the New York Heart Association. (1994). Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. (9th ed.). Boston: Little, Brown & Co. pp. 253–256. McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014;371:993-1004. Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, et al. Ivabradine and outcomes in chronic heart failure (SHIFT

2016 Clinical Practice Guidelines and Protocols in British Columbia

137. Acute and Chronic Heart Failure Full Text available with Trip Pro

outcomes. Detailed summaries of the key evidence supporting generally recommended treatments have been provided. For diagnostic recommendations a level of evidence C has been typically decided upon, because for the majority of diagnostic tests there are no data from randomized controlled trials (RCTs) showing that they will lead to reductions in morbidity and/or mortality. Practical guidance is provided for the use of the important disease-modifying drugs and diuretics. When possible, other relevant (...) microcirculation as alternative evidence for IHD. In clinical practice, a clear distinction between acquired and inherited cardiomyopathies remains challenging. In most patients with a definite clinical diagnosis of HF, there is no confirmatory role for routine genetic testing, but genetic counselling is recommended in patients with hypertrophic cardiomyopathy (HCM), ‘idiopathic’ DCM or arrhythmogenic right ventricular cardiomyopathy (ARVC) (see Section 5.10.1), since the outcomes of these tests may have

2016 European Society of Cardiology

138. Dyslipidaemias Full Text available with Trip Pro

kidney disease, familial hypercholesterolaemia, or very high levels of individual risk factors because such people are already at high-risk and need intensive risk factor advice. The reasons for retaining a system that estimates fatal as opposed to total fatal + non-fatal events are that non-fatal events are dependent on definition, developments in diagnostic tests and methods of ascertainment, all of which can vary, resulting in very variable multipliers to convert fatal to total events. In addition (...) of apoB. The analysis of apoB is accurate, with small variations, and is recommended as an alternative when available. Near patient testing is also available using dry chemistry methods. These methods may give a crude estimate, but should be verified by analysis in an established certified laboratory. 3.1 Fasting or non-fasting? Traditionally blood samples for lipid analysis have been drawn in the fasting state. As recently shown, fasting and non-fasting sampling give similar results for TC, LDL-C

2016 European Society of Cardiology

140. Entresto - sacubitril / valsartan

Marketing Authorisation holder MEB Medicines Evaluation Board MedDRA Medical Dictionary for Regulatory Activities MHRA Medicines and Healthcare Products Regulatory Agency MI Myocardial infarction MPA Medical Products Agency MME Membrane metallo-endopeptidase (neprilysin) MMP-2 Matrix metalloprotease-2 MPA Medical Products Agency MRA mineralocorticoid antagonist MRP Multi-drug resistance protein MS Mass spectrometry MTD Maximal tolerated dose MTP Multiple testing procedure NCO Nonclinical Overview NEP (...) of administrative information, complete quality data, non-clinical and clinical data based on applicants’ own tests and studies and/or bibliographic literature substituting/supporting certain tests or studies. Information on Paediatric requirements Pursuant to Article 7 of Regulation (EC) No 1901/2006, the application included an EMA Decision P/0106/2014 on the agreement of a paediatric investigation plan (PIP). At the time of submission of the application, the PIP P/0106/2014 was not yet completed as some

2015 European Medicines Agency - EPARs

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