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161. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes

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

162. 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

163. Management of Hypertension (HTN) in Primary Care

in practice 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 healthcare 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 (...) ischemic attack • Heart disease o Myocardial infarction o Angina o Coronary revascularization o Chronic heart failure • Chronic kidney disease o Diabetic nephropathy o Glomerulonephritis o Hypertensive renovascular disease • Aortic disease o Dissecting aneurysm o Fusiform aortic aneurysm • Peripheral arterial disease Routine laboratory tests Routine tests for all patients at the time of diagnosis of hypertension may include such tests as: • Urinalysis (UA); if the UA is positive for protein consider

2014 VA/DoD Clinical Practice Guidelines

164. 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

165. Chest X-rays for Diagnosing Pulmonary Infection as a Precipitant of Acute Heart Failure

precipitant of an HF exacerbation. (2) Technology Radiography is the application of x-rays to produce an image based on the internal physical properties of an object. By exploiting known physical properties of the human body, an image of internal structures and organs can be created. X-ray imaging tools are widely available and non-invasive. Pneumonia is typically diagnosed using a combination of clinical exams, chest x-ray, and laboratory tests. (9) Other diagnostic imaging tools for pneumonia include (...) , management during intercurrent illness or acute decompensation, and use of biomarkers. Can J Cardiol. 2007 Jan;23(1):21-45. (5) Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010 Jun;16(6):e1-194. (6) McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis

2013 Health Quality Ontario

166. Medical therapies to reduce chronic kidney disease progression and cardiovascular risk: anti-hypertensive/anti-proteinuric agents

in eGFR or rise in plasma creatinine after starting or increasing the dose of ACEI/ARB, but it is less than 25% (eGFR) or 30% (serum creatinine) of baseline, the test should be repeated in a further 1 – 2 weeks. Do not modify the ACEI/ARB dose if the change in eGFR 1 g/day of proteinuria (approximately equivalent to a ____________________________________________________________________________________________________________ Early Chronic Kidney Disease July 2012 Page 9 of 24 protein/creatinine ratio (...) . Anavekar NS, McMurray JJ, Velazquez EJ et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. New England Journal of Medicine. 2004; 351: 1285-1295. 4. Brantsma AH, Bakker SJL, Hillege HL et al. Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion. Nephrology Dialysis Transplantation. 2008; 23: 3851-8. 5. Chien K-L, Hsu H-C, Lee Y-T et al. Renal function and metabolic syndrome

2013 KHA-CARI Guidelines

167. Medical therapies to reduce chronic kidney disease progression and cardiovascular risk: lipid lowering therapy

July 2012 Page 6 of 14 REFERENCES 1. Green F and C R, An Overview of Chronic Kidney Disease in Australia. 2009, Australian Institute of Health and Welfare: Canberra. 2. National Chronic Kidney Disease Strategy. 2006, Kidney Health Australia. 3. Anavekar NS, McMurray JJ, Velazquez EJ et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. New England Journal of Medicine. 2004; 351: 1285-1295. 4. Brantsma AH, Bakker SJL, Hillege HL et al. Cardiovascular (...) In patients who were in the lipid treatment groups, the rate of decline in glomerular filtration rate was lower compared with controls (0.156 mL/min/month; 95%CI: 0.026 to 0.285 mL/min/month; P = 0.008) There was a significant difference in the mean weighted effect of treatment on change in urine protein or albumin excretion -0.283 (95%CI: -0.427 to - 0.139; P < 0.001), however the validity of combining these results is questionable as the chi-square test for heterogeneity between the studies

2013 KHA-CARI Guidelines

168. Symptoms, natural history and outcomes of early chronic kidney disease

(glomerular filtration rate (GFR) decline, cardiovascular events, etc.). BACKGROUND Chronic kidney disease is often detected as an incidental finding on pathology tests or during screening. In many patients it is asymptomatic until more advanced stages of CKD are reached. Despite the frequent paucity of symptoms, early stages of CKD are associated with an increased risk of adverse outcomes, and unrecognised complications may begin to develop in early stages of disease. Health provider and patient (...) . ________________________________________________________________________________________________________________________ Early Chronic Kidney Disease July 2012 Page 7 of 12 24. O'Hare AM, Bertenthal D, Covinsky KE et al. Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol. 2006; 17: 846-53. 25. Anavekar NS, McMurray JJ, Velazquez EJ et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004; 351: 1285-95. 26. McCullough PA, Nowak RM, Foreback C et al. Emergency evaluation of chest pain in patients with advanced

2013 KHA-CARI Guidelines

169. RE?LY: Dabigatran versus Warfarin in Patients with Atrial Fibrillation

were excluded. ? 77% of patients were managed at primary care centres. 15% were managed at anticoagulation clinics. ? Mean (SD): TTR 64% (20%), monthly frequency of INR testing 1.6 (1.3), time below therapeutic range 22% (19%) & above therapeutic range 13% (13%). - North American data (n=2167, 36%): mean (SD) TTR 67% (17%), algorithm consistency 64% (17%), time below therapeutic range 19% (15%) & above therapeutic range 14% (11%). ? Warfarin dose adjustments based on the above recommendations were (...) =diabetes ECG=electrocardiogram GI=gastrointestinal HF=heart failure Hgb=hemoglobin H 2 RA=histamine-2 receptor antagonist HTN=hypertension INR=international normalized ratio LFT=liver function test LVEF=left ventricular ejection fraction MI=myocardial infarction NNT=number needed to treat NNH=number needed to harm NS=not statistically significant NYHA=New York Heart Association PE=pulmonary embolism PPI=proton pump inhibitor TIA=transient ischemic attack VKA=vitamin K antagonist yr=year

2013 RxFiles

170. 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

171. 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

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

172. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary

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

173. 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

174. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

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

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2014 American Heart Association

175. 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

176. Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations from ESPGHAN and NASPGHAN

after 2-4 weeks 6 7 9 16 17 20 22 24 25 27 26 23 18 19 21 15 14 11 13 12 8 5 4 23 10 1 Alarm signs/ symptoms? Tailor testing for differential diagnosis Continue therapy Consider hypo- allergic formula for 2-4 weeks Response? Reconsider organic diseases No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes FIGURE 1. Algorithm (...) previous treatment been sufficient? Alarm signs/ symptoms? Normal results? Tailor testing for differential diagnosis Treat accordingly Intractable constipation Constipation confirmed? Consultation with mental health care Maintenance therapy Colonic transit time study to confirm constipation Doubts about the diagnosis of constipation? Colonic manometry (Rule out colonic neuro muscular disorders) Consider:  Mental health care  Biofeedback  ACE  Botox  SNS  TENS Consider:  Surgery  SNS  TENS

2014 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

177. Guidelines for the Prevention of Stroke in Women

Table 1. Applying Classification of Recommendation and Level of Evidence A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. *Data available from clinical trials or registries about the usefulness/efficacy

2014 Congress of Neurological Surgeons

178. Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence- based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances (...) for primary stroke prevention. 14,15 Some of the goals of such risk assessment tools are to identify people at elevated risk who might be unaware of their risk, to assess risk in the presence of >1 condition, to measure an individual’s risk that can be tracked and lowered by appropri- ate modifications, to estimate risk for selecting treatments or stratification in clinical trials, and to guide appropriate use of further diagnostic testing. Although stroke risk assessment tools exist, the complexi- ties

2014 American Heart Association

179. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (Secondary Stroke Prevention)

that enhance insulin sensitivity have also been shown to produce many of these improvements among people with the metabolic syndrome. 188,190–194 No adequately powered RCTs have tested the effective- ness of weight loss, diet, or exercise for primary prevention of stroke or other vascular clinical events among patients with the metabolic syndrome. No randomized trial of secondary preventive therapy has been conducted among patients who have had a stroke with the metabolic syndrome. Metabolic Syndrome (...) activity are associated with a 10% to 30% reduction in the incidence of stroke and CHD in both men and women. 195,199–201,208,209 These observations from epidemiological work, however, have not been tested in adequately designed clinical trials. In particular, no RCTs have examined the effectiveness of exercise for secondary prevention of stroke. Two trials using multimodal approaches that include physical activity are in progress and may help clarify the role of physical activity in secondary

2014 Congress of Neurological Surgeons

180. Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

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

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2014 American Heart Association

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