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201. ST-Elevation Myocardial Infarction: Guideline For the Management of

. Hyperglycemia .e112 10. Risk Assessment After STEMI .e113 10.1. Use of Noninvasive Testing for Ischemia Before Discharge: Recommendations . .e113 10.2. Assessment of LV Function: Recommendation .e114 10.3. Assessment of Risk for SCD: Recommendation .e114 11. Posthospitalization Plan of Care .e114 11.1. Posthospitalization Plan of Care: Recommendations .e114 11.1.1. The Plan of Care for Patients With STEMI .e114 11.1.2. Smoking Cessation .e116 11.1.3. Cardiac Rehabilitation .e116 11.1.4. Systems of Care (...) therapy. CABG indicates coronary artery bypass graft; DIDO, door-in–door-out; FMC, ?rst medical contact; LOE, Level of Evidence; MI, myocardial infarction; PCI, percutaneous coronary intervention; and STEMI, ST-elevation myocardial infarction. e86 O’Gara et al. JACC Vol. 61, No. 4, 2013 2013 ACCF/AHA STEMI Guideline: Full Text January 29, 2013:e78–140tutional quality improvement efforts, broader initiatives at a systems level are required to reduce total ischemic time, the principal determinant

2012 American College of Cardiology

202. Evolution of Critical Care Cardiology: Transformation of the Cardiovascular Intensive Care Unit and the Emerging Need for New Medical Staffing and Training Models Full Text available with Trip Pro

requiring critical care. Evolution of the CICU Early History of Critical Care Cardiology In the early 1960s, after the successful implementation of open- and then closed-chest defibrillation and the introduction of the first continuous electrocardiographic monitoring, the first coronary care units (CCUs) were formed with the premise that rapid identification and termination of peri-infarction arrhythmias could dramatically alter the natural history of acute myocardial infarction (MI). , The earliest (...) procedures within the Duke University Coronary Care Unit from 1989 to 2006. Data from Katz et al. STEMI indicates ST-segment–elevation myocardial infarction; NSTEMI, non–ST-segment–elevation myocardial infarction; PCI, percutaneous coronary intervention; and PA, pulmonary artery. Figure 2. Evolution of the cardiac intensive care unit. Advances in technology, medical care, critical care unit organization, and changes in the patient population have contributed to evolution of the contemporary cardiac

2012 American Heart Association

203. Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management Full Text available with Trip Pro

achievement, language (expressive and receptive), gross motor function, oral and speech motor control functions, and attention (executive control). Methods of vital organ support during infant heart surgery, including CPB and DHCA, may result in cerebral macroemboli and microemboli to the central nervous system , or a period of global cerebral ischemia and thereby contribute to observed DDs. These central nervous system events may contribute to the presence of acute arterial ischemic strokes or cerebral (...) Gerdes , J. William Gaynor , Kathleen A. Mussatto , Karen Uzark , Caren S. Goldberg , Walter H. JohnsonJr , Jennifer Li , Sabrina E. Smith , David C. Bellinger , and William T. Mahle and on behalf of the American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Stroke Council Originally published 30 Jul 2012 Circulation. 2012;126:1143–1172 You are viewing the most recent version of this article. Previous

2012 American Heart Association

204. Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families Full Text available with Trip Pro

what is known about adult and pediatric patient and family responses to the ICD; educational and informational needs; factors associated with various responses; and educational, psychological, and rehabilitative interventions to promote adjustment to the ICD and prevent or reduce adverse psychological responses. The statement concludes with evidence-based recommendations for the multidisciplinary practice team, describes important gaps in the knowledge base, and identifies future directions (...) isolation, transient depression, being shocked, fear of and anxiety associated with being shocked, problems associated with activity restrictions, and trying to live a normal life in the midst of dealing with a chronic heart condition. The inability to participate in full-contact organized sports was particularly burdensome to those who had genetically determined diseases that put them at increased risk for SCA. Stefanelli et al reported that 3 of 27 pediatric patients who had received repeated shocks

2012 American Heart Association

205. Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection Full Text available with Trip Pro

ischemia. , Withdrawal of Nondurable MCS Patients who receive nondurable MCS (either percutaneous or surgically placed) should always be evaluated for possible ventricular recovery, particularly in the setting of postcardiotomy shock, myocardial infarction, or myocarditis. Weaning can be performed by assessing clinical parameters (hemodynamics and echocardiographic left ventricular function) while MCS is temporarily reduced. Although uniform guidelines for weaning MCS do not exist, it is common (...) the concept and indication of bridge to recovery in which temporary MCS sustained the circulation until cardiac recovery. A robust experience with temporary MCS for failure to wean from bypass led to the application of MCS in nonpostcardiotomy settings such as cardiogenic shock caused by myocardial infarction, fulminant or acute myocarditis, or acute cardiac allograft dysfunction after heart transplantation. Compared with early options for MCS, modern devices ( ) provide longer duration and more versatile

2012 American Heart Association

206. Sexual Activity and Cardiovascular Disease Full Text available with Trip Pro

coronary revascularization or had a treadmill test without ischemia could resume sexual activity 3 to 4 weeks after MI. In contrast, the 2004 “ACC/AHA Guidelines for the Management of Patients with ST-elevation Myocardial Infarction” condoned sexual activity as early as 1 week after MI in the stable patient. Because participation of stable patients in cardiac rehabilitation exercise programs 1 week after MI has proved safe, resumption of sexual activity soon after uncomplicated MI seems reasonable (...) physical activity. If a patient can achieve an energy expenditure of ≥3 to 5 METs without demonstrating ischemia during exercise testing, then the risk for ischemia during sexual activity is very low. Sexual Activity and Myocardial Infarction Meta-analysis of 4 case-crossover studies, which consisted of 50% to 74% males predominantly in their 50s and 60s, showed that sexual activity was associated with a 2.70 increased relative risk of myocardial infarction (MI) compared with periods of time when

2012 American Heart Association

207. 2013 ACCF/AHA Guideline for the Management of Heart Failure Full Text available with Trip Pro

2011 Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update AHA/ACCF 2011 Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease ACCF/AHA/ACP/AATS/PCNA/SCAI/STS 2012 Guideline for the Management of ST-Elevation Myocardial Infarction ACCF/AHA 2013 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction ACCF/AHA 2013 Guidelines for the Management (...) , Enrollment, and Delivery of Cardiac Rehabilitation/Secondary Prevention Programs at Clinical Centers and Beyond AHA/AACVPR 2011 Decision Making in Advanced Heart Failure AHA 2012 Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection AHA 2012 Advanced Chronic Heart Failure ESC 2007 Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation AHA/ASA 2012 Third Universal Definition of Myocardial Infarction ESC/ACCF/AHA/WHF 2012

2013 American Heart Association

208. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk Full Text available with Trip Pro

nutritional supplements may not have similar effects and are not considered “lifestyle” interventions. The Work Group focused on CVD risk factors to provide a free-standing Lifestyle document and to inform the Blood Cholesterol guideline and the hypertension panel. It also recognized that RCTs examining the effects on hard outcomes (myocardial infarction, stroke, heart failure, and CVD-related death) are difficult if not impossible to conduct for several reasons (eg, long-term adherence to dietary changes (...) cardiovascular disease risk or ordering an ECG as part of the initial diagnostic work-up for a patient presenting with possible MI). Those situations should be limited and the rationale explained clearly by the Work Group. † Net benefit is defined as benefits minus risks/harms of the service/intervention. ECG indicates electrocardiogram; MI, myocardial infarction; and NHLBI, National Heart, Lung, and Blood Institute. Table 3 NHLBI Quality Rating of the Strength of Evidence Type of Evidence Quality Rating

2013 American Heart Association

209. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults Full Text available with Trip Pro

to <25.0 kg/m 2 ) are associated with elevated risk of fatal CHD in both sexes. Strength of Evidence: Moderate ES3. Among overweight or obese adults, analyses of continuous BMI show that the greater the BMI, the higher the risk of fatal stroke overall, as well as ischemic and hemorrhagic stroke. The same relationship holds for combined fatal and nonfatal ischemic stroke but across the entire BMI range, not just in overweight and obese adults. There is no evidence from meta-analyses, pooled analyses (...) recommendation when the evidence quality is moderate, such as smoking cessation to reduce CVD risk or ordering an ECG as part of the initial diagnostic work-up for a patient presenting with possible MI). Those situations should be limited and the rationale explained clearly by the Work Group. † Net benefit is defined as benefits minus risks/harms of the service/intervention. CVD indicates cardiovascular disease; ECG, electrocardiogram; MI, myocardial infarction; and NHLBI, National Heart, Lung, and Blood

2013 American Heart Association

210. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk Full Text available with Trip Pro

, defined as nonfatal myocardial infarction or coronary heart disease (CHD) death or fatal or nonfatal stroke, over a 10-year period among people free from ASCVD at the beginning of the period. In addition, through evaluation of evidence developed by systematic reviews of the literature, the Work Group addressed the following 2 CQs: CQ1. “What is the evidence with regard to reclassification or contribution to risk assessment when high-sensitivity C-reactive protein (hs-CRP), apolipoprotein B (ApoB (...) alone). Rather, the Work Group derived risk equations from community-based cohorts that are broadly representative of the US population of whites and African Americans, and the Work Group focused on estimation of first hard ASCVD events (defined as first occurrence of nonfatal myocardial infarction, CHD death, or fatal or nonfatal stroke) as the outcome of interest because they were deemed to be of greater relevance to both patients and providers. The focus on hard ASCVD, rather than CHD alone

2013 American Heart Association

211. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults Full Text available with Trip Pro

for ASCVD risk-reduction benefits, adverse effects, drug–drug interactions, and consider patient preferences for treatment. This discussion also provides the opportunity to re-emphasize healthy-lifestyle habits and address other risk factors. Clinical ASCVD is defined by the inclusion criteria for the secondary-prevention statin RCTs (acute coronary syndromes, a history of MI, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral (...) and men with clinical ASCVD (defined from the RCT inclusion criteria as acute coronary syndromes; history of MI, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed

2013 American Heart Association

212. Variable Impact of State Legislative Advocacy on Registry Participation and Regional Systems of Care Implementation Full Text available with Trip Pro

(QI) registry participation all promote the widespread dissemination of guideline-based evidence into actual practice. As a result, policy statements from the American Heart Association/American Stroke Association (AHA/ASA) advocate for the creation of regional systems of care for various time-critical diagnoses, including ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest resuscitation, and acute stroke. Creation of these regional networks requires multidisciplinary (...) for designating comprehensive stroke centers. Comprehensive stroke centers are highly specialized facilities capable of delivering the full range of care needed for complex stroke patients, including advanced neuroimaging capabilities, a neurosurgical team, and onsite rehabilitation services. Since its inception in 2006, the natural distribution of primary and comprehensive stroke centers in New Jersey has formed a network in which each primary stroke center is linked to a comprehensive stroke center in a hub

2013 American Heart Association

213. Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork Full Text available with Trip Pro

on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research Joyce A. Wahr , Richard L. Prager , J.H. AbernathyIII , Elizabeth A. Martinez , Eduardo Salas , Patricia C. Seifert , Robert C. Groom , Bruce D. Spiess , Bruce E. Searles , Thoralf M. SundtIII , Juan A. Sanchez , Scott A. Shappell , Michael H. Culig , Elizabeth H. Lazzara , David C. Fitzgerald , Vinod H. Thourani , Pirooz Eghtesady , John S. Ikonomidis , Michael R. England , Frank W. Sellke , and Nancy A. Nussmeier (...) and on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research Originally published 5 Aug 2013 Circulation. 2013;128:1139–1169 You are viewing the most recent version of this article. Previous versions: Introduction The cardiac surgical operating room (OR) is a complex environment in which highly trained subspecialists interact with each other using sophisticated equipment

2013 American Heart Association

214. Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners Full Text available with Trip Pro

studies (n=10) in patients (and spouses) with cardiovascular disease (cardiac disease, n=9; vascular disease, n=1). “Neither/nor or negative” indicates results were neither positive nor negative or were negative. * Myocardial infarction (n=8 studies). † Myocardial infarction/coronary artery bypass surgery (n=1). ‡ Stroke (n=1). Sexual Counseling: Sexual Health Topics of Concern for the Patient With CVD General Strategies/Advice Recommendation for Medication Effects During sexual counseling, it can (...) about sexual functioning and a safe return to sexual activity related to myocardial infarction (MI), , coronary artery bypass graft (CABG) surgery, stroke, and heart failure (HF). Patients who have experienced a coronary event may report issues related to resuming sexual activity that are both physiological and psychological, such as general anxiety, fear of having another MI, feeling unwanted by their partner or not good enough, changes in self-perceptions, inadequate knowledge regarding the impact

2013 American Heart Association

215. Synthesizing Lessons Learned From Get With The Guidelines Full Text available with Trip Pro

through reduction in readmissions, complications, and recurrent events. • Substantial reductions in LOS were associated with the implementation of GWTG-Stroke among patients with stroke and transient ischemic attack admissions, suggesting that the acute-care intervention may have decreased in hospital complications and made care more efficient. • GWTG has improved care for all patient groups and has substantially reduced or, in some cases, eliminated, inequities in care between men and women, older (...) is likely driven by recommendations from the Brain Attack Coalition and ASA that primary stroke centers should engage in ongoing continuous quality improvement, and by the proliferation of state regulations or legislation requiring designation of centers that receive acute stroke patients. , In addition, many hospitals use GWTG-Stroke as the platform for data collection for submission to The Joint Commission, to the Centers for Disease Control and Prevention Paul Coverdell Registry, or to public health

2013 American Heart Association

216. Moving From Political Declaration to Action on Reducing the Global Burden of Cardiovascular Diseases Full Text available with Trip Pro

.” Now in 2013, this target, as well as 8 additional targets addressing modifiable risk factors and committing to the use of essential medicines, technologies, and drug therapies to prevent heart attacks and strokes, have been adopted as part of a global monitoring framework and included in the World Health Organization’s Global Action Plan for the Prevention and Control of NCDs (see online-only Appendix for a list of the globally agreed targets and indicators). , Figure. Reducing cardiovascular (...) across the life span. Acknowledging that health systems in low- and middle-income countries have been built around infectious disease, these systems must now transform to address CVD morbidity and mortality. Tackling the growing burden of NCDs requires not only a whole of government approach but also a whole of society approach involving nongovernmental organizations, local communities, and industry, where appropriate. The CVD civil society community of heart and stroke foundations and societies

2013 American Heart Association

217. Guide to the Assessment of Physical Activity: Clinical and Research Applications Full Text available with Trip Pro

, and and on behalf of the American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health and Cardiovascular, Exercise, Cardiac Rehabilitation and Prevention Committee of the Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing Originally published 14 Oct 2013 Circulation. 2013;128:2259–2279 You are viewing the most recent version of this article. Previous versions: Introduction Approximately 60 years ago, the foundational works of Jeremy

2013 American Heart Association

218. Exercise Standards for Testing and Training Full Text available with Trip Pro

or complete heart block Hypertrophic obstructive cardiomyopathy with severe resting gradient Recent stroke or transient ischemic attack Mental impairment with limited ability to cooperate Resting hypertension with systolic or diastolic blood pressures >200/110 mm Hg Uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism Subject Preparation Preparations for exercise testing include the following: The purpose of the test should be clear in advance (...) , Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention Gerald F. Fletcher , Philip A. Ades , Paul Kligfield , Ross Arena , Gary J. Balady , Vera A. Bittner , Lola A. Coke , Jerome L. Fleg , Daniel E. Forman , Thomas C. Gerber , Martha Gulati , Kushal Madan , Jonathan Rhodes , Paul D. Thompson , and Mark A. Williams and on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council

2013 American Heart Association

219. Treatment and recommendations for homeless people with Chronic Non-Malignant Pain

clinicians report that chronic pain is extremely common among their patients and is particularly challenging to treat. Although the prevalence of chronic pain among people experiencing homelessness remains largely unknown, this population suffers disproportionately from health problems that are associated with chronic pain — including trauma, peripheral vascular disease, viral hepatitis, HIV/AIDS, psychiatric illness, and substance use disorders (O‘Connell, 2004; Menchaca et al., 2008; Highley, 2008 (...) problems, including psychological sequelae of trauma and cognitive impairment. These factors also make adherence to a treatment plan for chronic pain more difficult. Barriers to effective pain management for homeless people include poor understanding of pain management in the general medical community, mutual mistrust between homeless persons and medical providers, lack of access to appropriate pain specialty clinics and other opportunities for rehabilitation, and lack of clear treatment

2011 National Health Care for the Homeless Council

220. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease

., stroke, vascular access loss, hypertension). (1B) **Consistent with Recommendations #3.4.2 and 3.4.3. ***Based on patient symptoms and overall clinical goals including avoidance of transfusionand improvement in anemia-related symptoms, and afterexclusion of active infection and other causes of ESA hyporesponsiveness. 284 Kidney International Supplements (2012) 2, 283–287 summary of recommendation statements3.3: W e recommend using ESA therapy with great caution, if at all, in CKD patients with active (...) malignancy—in particular when cure is the anticipated outcome—(1B), a history of stroke (1B), or a history of malignancy (2C). 3.4.1: For adult CKD ND patients with Hb concentrationZ10.0 g/dl (Z100 g/l), we suggest that ESA therapy not be initiated. (2D) 3.4.2: For adult CKD ND patients with Hb concentrationo10.0 g/dl (o100 g/l) we suggest that the decision whether to initiate ESA therapy be individualized based on the rate of fall of Hb concentration, prior response to iron therapy, the risk of needing

2012 National Kidney Foundation


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