20 abril 2015

CIRCULATION. AHA Scientific Statement. Congenital Heart Disease in the Older Adult

Ami B. Bhatt, MD; Elyse Foster, MD, FAHA; Karen Kuehl, MD, MPH; Joseph Alpert, MD; Stephen Brabeck, MD; Stephen Crumb, DNP; William R. Davidson Jr, MD; Michael G. Earing, MD; Brian B. Ghoshhajra, MD; Tara Karamlou, MD; Seema Mital, MD, FAHA; Jennifer Ting, MD; Zian H. Tseng, MD, MAS; on behalf of the American Heart Association Council on Clinical Cardiology

Introduction: The population of adults with congenital heart disease (ACHD) has increased dramatically over the past few decades, with many people who are now middle-aged and some in the geriatric age range. This improved longevity is leading to increased use of the medical system for both routine and episodic care, and caregivers need to be prepared to diagnose, follow up, and treat the older adult with congenital heart disease (CHD). The predictable natural progression of CHD entities and sequelae of previous interventions must now be treated in the setting of late complications, acquired cardiac disease, multiorgan effects of lifelong processes, and the unrelenting process of aging. Despite the advances in this field, death rates in the population from 20 to >70 years of age may be twice to 7 times higher for the ACHD population than for their peers.1

23 abril 2015

CIRCULATION. AHA Scientific Statement. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography

Michael H. Gewitz, MD, FAHA, Co-Chair; Robert S. Baltimore, MD, Co-Chair; Lloyd Y. Tani, MD, FAHA; Craig A. Sable, MD, FAHA; Stanford T. Shulman, MD; Jonathan Carapetis, MBBS; Bo Remenyi, MBBS; Kathryn A. Taubert, PhD, FAHA; Ann F. Bolger, MD, FAHA; Lee Beerman, MD; Bongani M. Mayosi, MBChB; Andrea Beaton, MD; Natesa G. Pandian, MD; Edward L. Kaplan, MD, FAHA; on behalf of the American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young

Background: Acute rheumatic fever remains a serious healthcare concern for the majority of the world’s population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever.

14 julio 2014

CIRCULATION. AHA Science Advisory. Status of Cardiovascular Disease and Stroke in Hispanics/Latinos in the United States

Carlos J. Rodriguez, MD, MPH, FAHA, Chair; Matthew Allison, MD, MPH, FAHA; Martha L. Daviglus, MD, PhD, FAHA; Carmen R. Isasi, MD, PhD, FAHA; Colleen Keller, PhD, FAHA; Enrique C. Leira, MD, MS, FAHA; Latha Palaniappan, MD, MS, FAHA; Ileana L. Piña, MD, MPH, FAHA; Sarah M. Ramirez, PhD, MPH; Beatriz Rodriguez, PhD, MPH; Mario Sims, PhD, MS, FAHA; on behalf of the American Heart Association Council on Epidemiology and Prevention, Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing

Background and Purpose: This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA’s 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers.

09 mayo 2014

CIRCULATION. HRS/ACC/AHA Expert Consensus Statement. 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

Fred M. Kusumoto, MD, FHRS, (Chair)1; Hugh Calkins, MD, FHRS, (Chair)2; John Boehmer, MD3§; Alfred E. Buxton, MD4*; Mina K. Chung, MD, FHRS5; Michael R. Gold, MD, PhD, FHRS6; Stefan H. Hohnloser, MD, FHRS7; Julia Indik, MD, PhD, FHRS8; Richard Lee, MD, MBA9‡; Mandeep R. Mehra, MD10*; Venu Menon, MD11†; Richard L. Page, MD, FHRS12†; Win-Kuang Shen, MD13*; David J. Slotwiner, MD14; Lynne Warner Stevenson, MD15†; Paul D. Varosy, MD, FHRS16; Lisa Welikovitch, MD17

Introduction: The implantable cardioverter defibrillator (ICD) has emerged as an important treatment option for selected patients who are at risk of sudden cardiac death. Randomized trials have consistently shown that ICD implantation reduces mortality in patients with heart failure and reduced left ventricular function, as well as in patients who have suffered a cardiac arrest.

30 agosto 2014

EUROPEAN HEART JOURNAL. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism

Stavros V. Konstantinides , Adam Torbicki , Giancarlo Agnelli , Nicolas Danchin , David Fitzmaurice , Nazzareno Galiè , J. Simon R. Gibbs , Menno V. Huisman , Marc Humbert , Nils Kucher , Irene Lang , Mareike Lankeit , John Lekakis , Christoph Maack , Eckhard Mayer , Nicolas Meneveau , Arnaud Perrier , Piotr Pruszczyk , Lars H. Rasmussen , Thomas H. Schindler , Pavel Svitil , Anton Vonk Noordegraaf , Jose Luis Zamorano , Maurizio Zompatori

Preamble: Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

30 agosto 2014

EUROPEAN HEART JOURNAL. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Raimund Erbel , Victor Aboyans , Catherine Boileau , Eduardo Bossone , Roberto Di Bartolomeo , Holger Eggebrecht , Arturo Evangelista , Volkmar Falk , Herbert Frank , Oliver Gaemperli , Martin Grabenwöger , Axel Haverich , Bernard Iung , Athanasios John Manolis , Folkert Meijboom , Christoph A. Nienaber , Marco Roffi , Hervé Rousseau , Udo Sechtem , Per Anton Sirnes , Regula S. von Allmen , Christiaan J.M. Vrints , ,

Preamble: Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

30 agosto 2014

EUROPEAN HEART JOURNAL. 2014 ESC/EACTS Guidelines on myocardial revascularization

Stephan Windecker , Philippe Kolh , Fernando Alfonso , Jean-Philippe Collet , Jochen Cremer , Volkmar Falk , Gerasimos Filippatos , Christian Hamm , Stuart J. Head , Peter Jüni , A. Pieter Kappetein , Adnan Kastrati , Juhani Knuuti , Ulf Landmesser , Günther Laufer , Franz-Josef Neumann , Dimitrios J. Richter , Patrick Schauerte , Miguel Sousa Uva , Giulio G. Stefanini , David Paul Taggart , Lucia Torracca , Marco Valgimigli , William Wijns , Adam Witkowski

Preamble: Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice; however, the final decisions concerning an individual patient must be made by the responsible health professional(s), in consultation with the patient and caregiver as appropriate.

01 mayo 2015

JACC. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care. Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiología Intervencionista; Affirmation of Value by the Canadian Association of Interventional Cardiology–Association Canadienne de Cardiologie d’intervention

Charanjit S. Rihal, MD, FSCAI, FACC1; Srihari S. Naidu, MD, FSCAI, FACC, FAHA2; Michael M. Givertz, MD, FACC3; Wilson Y. Szeto, MD4; James A. Burke, MD, PhD, FACC5; Navin K. Kapur, MD6; Morton Kern, MD, MSCAI, FACC7; Kirk N. Garratt, MD, FSCAI, FACC8; James A. Goldstein, MD, FSCAI, FACC9; Vivian Dimas, MD10; Thomas Tu, MD11

This article provides a brief summary of the relevant recommendations and references related to percutaneous mechanical circulatory support. The goal was to provide the clinician with concise, evidence-based contemporary recommendations, and the supporting documentation to encourage their application. The full text includes disclosure of all relevant relationships with industry for each writing committee member. A fundamental aspect of all expert consensus statements is that these carefully developed, evidence-based documents can neither encompass all clinical circumstances, nor replace the judgment of individual physicians in management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring percutaneous mechanical circulatory support.

01 mayo 2015

JACC. Treatment of Hypertension in Patients With Coronary Artery Disease. A Scientific Statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension

Clive Rosendorff, MD, PhD, DScMed, FAHA, FACC, FASH; Daniel T. Lackland, DrPH, FAHA, FASH; Matthew Allison, MD, FAHA; Wilbert S. Aronow, MD, FAHA, FACC; Henry R. Black, MD, FAHA, FASH; Roger S. Blumenthal, MD, FAHA, FACC; Christopher P. Cannon, MD, FAHA, FACC; James A. de Lemos, MD, FAHA, FACC; William J. Elliott, MD, PhD, FASH; Laura Findeiss, MD, FAHA; Bernard J. Gersh, MB ChB, DPhil, FAHA, MACC; Joel M. Gore, MD, FAHA, FACC; Daniel Levy, MD, FACC; Janet B. Long, MSN, FAHA; Christopher M. O’Connor, MD, FACC; Patrick T. O’Gara, MD, FAHA, FACC; Olugbenga Ogedegbe, MD, MPH, FASH; Suzanne Oparil, MD, FAHA, FACC, FASH; William B. White, MD, FAHA, FASH

This is an update of the American Heart Association (AHA) scientific statement “Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention,” published in 2007 (1). A number of important studies have been published since that date that serve to modify or at least to further refine the recommendations of that statement, so an update was considered appropriate and timely. Because an AHA/American College of Cardiology (ACC)/American Society of Hypertension guideline on the treatment of hypertension in primary prevention is in process, this document is concerned with the epidemiology of hypertension and its treatment in secondary prevention, specifically in the setting of coronary artery disease (CAD).

09 febrero 2015

CIRCULATION. AHA Scientific Statement. Secondary Prevention After Coronary Artery Bypass Graft Surgery

Alexander Kulik, MD, MPH, FAHA, Chair; Marc Ruel, MD, MPH, FAHA, Co-Chair; Hani Jneid, MD, FAHA; T. Bruce Ferguson, MD, FAHA; Loren F. Hiratzka, MD, FAHA; John S. Ikonomidis, MD, PhD, FAHA; Francisco Lopez-Jimenez, MD, MSc, FAHA; Sheila M. McNallan, MPH; Mahesh Patel, MD; Véronique L. Roger, MD, MPH, FAHA; Frank W. Sellke, MD, FAHA; Domenic A. Sica, MD, FAHA; Lani Zimmerman, PhD, RN; on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia

Nearly 400 000 coronary artery bypass graft surgery (CABG) procedures are performed annually in the United States.1 A proven therapy for nearly 50 years, CABG is the most durable and complete treatment of ischemic heart disease. However, in the months and years that follow surgery, patients who have undergone CABG remain at risk for subsequent ischemic events as a result of native coronary artery disease (CAD) progression and the development of vein graft atherosclerosis. Secondary therapies therefore play a key role in the maintenance of native and graft vessel patency and in the prevention of adverse cardiovascular outcomes. Postoperative antiplatelet agents and lipid-lowering therapy continue to be the mainstay of secondary prevention after coronary surgical revascularization. Other opportunities for improving long-term clinical outcomes after CABG include the aggressive management of hypertension and diabetes mellitus, smoking cessation, weight loss, and cardiac rehabilitation (CR). Secondary preventive therapies help maintain long-term graft patency and help patients obtain the highest level of physical health and quality of life after CABG.

23 febrero 2015

CIRCULATION. AHA Scientific Statement. Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome

Jeffrey B. Washam, PharmD, FAHA, Chair; Charles A. Herzog, MD, FAHA; Amber L. Beitelshees, PharmD, MPH, FAHA; Mauricio G. Cohen, MD; Timothy D. Henry, MD; Navin K. Kapur, MD; Jessica L. Mega, MD, MPH, FAHA; Venu Menon, MD, FAHA; Robert L. Page II, PharmD, MSPH, FAHA; L. Kristin Newby, MD, MHS, FAHA, Co-Chair; on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, Council on Functional Genomics and Translational Biology, Council on the Kidney in Cardiovascular Disease, and Council on Quality of Care and Outcomes Research

Chronic kidney disease (CKD) is frequently encountered among patients presenting with acute coronary syndrome (ACS). Recent data from the National Cardiovascular Data Registry–Acute Coronary Treatment and Intervention Outcomes Network (NCDR-ACTION) reported CKD (defined as estimated creatinine clearance [CrCl] <60 mL·min−1·1.73 m−2) prevalence rates of 30.5% among patients presenting with ST-segment–elevation myocardial infarction (STEMI) and 42.9% among patients presenting with non–ST-segment–elevation myocardial infarction (NSTEMI).1 The presence of CKD among patients presenting with ACS has been associated with worse outcomes, including higher rates of mortality and bleeding.2–4 Despite the increased risk for adverse outcomes, CKD patients presenting with ACS are less likely to receive evidence-based therapies, including medications.1 In addition, patients with CKD have been underrepresented in randomized controlled trials of ACS pharmacotherapy.5,6 Thus, the net effect is a relative lack of evidence and potential for uncertainty in selecting medications in this high-risk population. The purpose of this scientific statement is to provide a comprehensive review of the published literature and provide recommendations on the use of evidence-based pharmacotherapies in CKD patients presenting with ACS.

31 marzo 2015

CIRCULATION. AHA/ACC/ASH Scientific Statement. Treatment of Hypertension in Patients With Coronary Artery Disease

Clive Rosendorff, MD, PhD, DScMed, FAHA, FACC, FASH, Chair; Daniel T. Lackland, DrPH, FAHA, FASH, Co-Chair; Matthew Allison, MD, FAHA; Wilbert S. Aronow, MD, FAHA, FACC; Henry R. Black, MD, FAHA, FASH; Roger S. Blumenthal, MD, FAHA, FACC; Christopher P. Cannon, MD, FAHA, FACC; James A. de Lemos, MD, FAHA, FACC; William J. Elliott, MD, PhD, FASH; Laura Findeiss, MD, FAHA; Bernard J. Gersh, MB ChB, DPhil, FAHA, MACC; Joel M. Gore, MD, FAHA, FACC; Daniel Levy, MD, FACC; Janet B. Long, MSN, FAHA; Christopher M. O’Connor, MD, FACC; Patrick T. O’Gara, MD, FAHA, FACC; Gbenga Ogedegbe, MD, MPH, FASH; Suzanne Oparil, MD, FAHA, FACC, FASH; William B. White, MD, FAHA, FASH; on behalf of the American Heart Association, American College of Cardiology, and American Society of Hypertension

This is an update of the American Heart Association (AHA) scientific statement “Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention,” published in 2007.1 A number of important studies have been published since that date that serve to modify or at least to further refine the recommendations of that statement, so an update was considered appropriate and timely. Because an AHA/American College of Cardiology (ACC)/American Society of Hypertension guideline on the treatment of hypertension in primary prevention is in process, this document is concerned with the epidemiology of hypertension and its treatment in secondary prevention, specifically in the setting of coronary artery disease (CAD).

01 diciembre 2014

JACC. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society

Craig T. January, MD, PhD, FACC; L. Samuel Wann, MD, MACC, FAHA; Joseph S. Alpert, MD, FACC, FAHA; Hugh Calkins, MD, FACC, FAHA, FHRS; Joaquin E. Cigarroa, MD, FACC; Joseph C. Cleveland, MD, FACC; Jamie B. Conti, MD, FACC, FHRS; Patrick T. Ellinor, MD, PhD, FAHA; Michael D. Ezekowitz, MB, ChB, FACC, FAHA; Michael E. Field, MD, FACC, FHRS; Katherine T. Murray, MD, FACC, FAHA, FHRS; Ralph L. Sacco, MD, FAHA; William G. Stevenson, MD, FACC, FAHA, FHRS; Patrick J. Tchou, MD, FACC; Cynthia M. Tracy, MD, FACC, FAHA; Clyde W. Yancy, MD, FACC, FAHA

Preamble: The medical profession should play a central role in evaluating the evidence related to drugs, devices, and procedures for the detection, management, and prevention of disease. When properly applied, expert analysis of available data on the benefits and risks of these therapies and procedures can improve the quality of care, optimize patient outcomes, and favorably affect costs by focusing resources on the most effective strategies. An organized and directed approach to a thorough review of evidence has resulted in the production of clinical practice guidelines that assist clinicians in selecting the best management strategy for an individual patient. Moreover, clinical practice guidelines can provide a foundation for other applications, such as performance measures, appropriate use criteria, and both quality improvement and clinical decision support tools.

01 diciembre 2014

JACC. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Ezra A. Amsterdam, MD, FACC; Nanette K. Wenger, MD, MACC, FAHA; Ralph G. Brindis, MD, MPH, MACC, FSCAI; Donald E. Casey, MD, MPH, MBA, FACP, FAHA; Theodore G. Ganiats, MD; David R. Holmes, MD, MACC; Allan S. Jaffe, MD, FACC, FAHA; Hani Jneid, MD, FACC, FAHA, FSCAI; Rosemary F. Kelly, MD; Michael C. Kontos, MD, FACC, FAHA; Glenn N. Levine, MD, FACC, FAHA; Philip R. Liebson, MD, FACC, FAHA; Debabrata Mukherjee, MD, FACC; Eric D. Peterson, MD, MPH, FACC, FAHA; Marc S. Sabatine, MD, MPH, FACC, FAHA; Richard W. Smalling, MD, PhD, FACC, FSCAI; Susan J. Zieman, MD, PhD, FACC

Preamble: The American College of Cardiology (ACC) and the American Heart Association (AHA) are committed to the prevention and management of cardiovascular diseases through professional education and research for clinicians, providers, and patients. Since 1980, the ACC and AHA have shared a responsibility to translate scientific evidence into clinical practice guidelines (CPGs) with recommendations to standardize and improve cardiovascular health. These CPGs, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care.

01 febrero 2014

JACC. ACC/AHA/SCAI/AMA–Convened PCPI/NCQA 2013 Performance Measures for Adults Undergoing Percutaneous Coronary Intervention. A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures, the Society for Cardiovascular Angiography and Interventions, the American Medical Association–Convened Physician Consortium for Performance Improvement, and the National Committee for Quality Assurance

Brahmajee K. Nallamothu, MD, MPH, FACC, FAHA; Carl L. Tommaso, MD, FACC, FAHA, FSCAI; H. Vernon Anderson, MD, FACC, FAHA, FSCAI; Jeffrey L. Anderson, MD, FACC, FAHA, MACP; Joseph C. Cleveland, MD; R. Adams Dudley, MD, MBA; Peter Louis Duffy, MD, MMM, FACC, FSCAI; David P. Faxon, MD, FACC, FAHA; Hitinder S. Gurm, MD, FACC; Lawrence A. Hamilton; Neil C. Jensen, MHA, MBA; Richard A. Josephson, MD, MS, FACC, FAHA, FAACVPR; David J. Malenka, MD, FACC, FAHA; Calin V. Maniu, MD, FACC, FAHA, FSCAI; Kevin W. McCabe, MD; James D. Mortimer; Manesh R. Patel, MD, FACC; Stephen D. Persell, MD, MPH; John S. Rumsfeld, MD, PhD, FACC, FAHA; Kendrick A. Shunk, MD, PhD, FACC, FAHA, FSCAI; Sidney C. Smith, MD, FACC, FAHA, FACP; Stephen J. Stanko, MBA, BA, AA; Brook Watts, MD, MS

Preamble: American College of Cardiology (ACC)/American Heart Association (AHA) performance measure sets can serve as vehicles to accelerate appropriate translation of scientific evidence into clinical practice. These documents are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of their care and identify opportunities for improvement.