23 septiembre 2014

CIRCULATION. AHA/ACC Guideline. 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, Chair†; Nanette K. Wenger, MD, MACC, FAHA, Vice Chair*†; Ralph G. Brindis, MD, MPH, MACC, FSCAI‡; Donald E. Casey Jr, MD, MPH, MBA, FACP, FAHA§; Theodore G. Ganiats, MD‖; David R. Holmes Jr, 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.

23 septiembre 2014

CIRCULATION. 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

Ezra A. Amsterdam, MD, FACC, Chair†; Nanette K. Wenger, MD, MACC, FAHA, Vice Chair*†; Ralph G. Brindis, MD, MPH, MACC, FSCAI‡; Donald E. Casey Jr, MD, MPH, MBA, FACP, FAHA§; Theodore G. Ganiats, MD‖; David R. Holmes Jr, 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 agosto 2014

CIRCULATION. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Lee A. Fleisher, MD, FACC, FAHA, Chair†; Kirsten E. Fleischmann, MD, MPH, FACC, Vice Chair†; Andrew D. Auerbach, MD, MPH†; Susan A. Barnason, PhD, RN, FAHA†; Joshua A. Beckman, MD, FACC, FAHA, FSVM*‡; Biykem Bozkurt, MD, PhD, FACC, FAHA*§; Victor G. Davila-Roman, MD, FACC, FASE*†; Marie D. Gerhard-Herman, MD†; Thomas A. Holly, MD, FACC, FASNC*‖; Garvan C. Kane, MD, PhD, FAHA, FASE¶; Joseph E. Marine, MD, FACC, FHRS#; M. Timothy Nelson, MD, FACS**; Crystal C. Spencer, JD††; Annemarie Thompson, MD‡‡; Henry H. Ting, MD, MBA, FACC, FAHA§§; Barry F. Uretsky, MD, FACC, FAHA, FSCAI‖‖; Duminda N. Wijeysundera, MD,

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 agosto 2014

CIRCULATION. ACC/AHA Clinical Practice Guideline. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Lee A. Fleisher, MD, FACC, FAHA, Chair†; Kirsten E. Fleischmann, MD, MPH, FACC, Vice Chair†; Andrew D. Auerbach, MD, MPH†; Susan A. Barnason, PhD, RN, FAHA†; Joshua A. Beckman, MD, FACC, FAHA, FSVM*‡; Biykem Bozkurt, MD, PhD, FACC, FAHA*§; Victor G. Davila-Roman, MD, FACC, FASE*†; Marie D. Gerhard-Herman, MD†; Thomas A. Holly, MD, FACC, FASNC*‖; Garvan C. Kane, MD, PhD, FAHA, FASE¶; Joseph E. Marine, MD, FACC, FHRS#; M. Timothy Nelson, MD, FACS**; Crystal C. Spencer, JD††; Annemarie Thompson, MD‡‡; Henry H. Ting, MD, MBA, FACC, FAHA§§; Barry F. Uretsky, MD, FACC, FAHA, FSCAI‖‖; Duminda N. Wijeysundera, MD, PhD, Evidence Review Committee Chair

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 agosto 2014

CIRCULATION. ACC/AHA Systematic Review Report. Perioperative Beta Blockade in Noncardiac Surgery: A Systematic Review for the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Duminda N. Wijeysundera, MD, PhD, ERC Chair; Dallas Duncan, MD, MHSc*; Chileshe Nkonde-Price, MD, MS*; Salim S. Virani, MD, PhD, FACC, FAHA*; Jeffrey B. Washam, PharmD, FAHA*; Kirsten E. Fleischmann, MD, MPH, FACC, Perioperative Guideline Vice Chair; Lee A. Fleisher, MD, FACC, FAHA, Perioperative Guideline Chair

Objective: To review the literature systematically to determine whether initiation of beta blockade within 45 days prior to noncardiac surgery reduces 30-day cardiovascular morbidity and mortality rates.

24 febrero 2014

CIRCULATION. AHA Scientific Statement. Depression as a Risk Factor for Poor Prognosis Among Patients With Acute Coronary Syndrome: Systematic Review and Recommendations. A Scientific Statement From the American Heart Association

udith H. Lichtman, PhD, MPH, Co-Chair; Erika S. Froelicher, RN, MA, MPH, PhD, FAHA, Co-Chair; James A. Blumenthal, PhD, ABPP; Robert M. Carney, PhD; Lynn V. Doering, RN, DNSc, FAHA; Nancy Frasure-Smith, PhD; Kenneth E. Freedland, PhD; Allan S. Jaffe, MD; Erica C. Leifheit-Limson, PhD; David S. Sheps, MD, MSPH, FAHA; Viola Vaccarino, MD, PhD, FAHA; Lawson Wulsin, MD; on behalf of the American Heart Association Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing

Background: Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome.

01 diciembre 2014

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

Stavros V. Konstantinides, MD, PhD, FESC

The most clinically relevant new aspects of the 2014 version of the ESC Guidelines (published in Issue 43 of this volume) when compared with the previous version published in 2008 relate to

01 octubre 2014

JACC. SCAI/AATS/ACC/STS Operator and Institutional Requirements for Transcatheter Valve Repair and Replacement. Part II. Mitral Valve

Carl L. Tommaso, MD, MSCAI1; David A. Fullerton, MD2; Ted Feldman, MD, FESC, FACC, MSCAI3; Larry S. Dean, MD, MSCAI, FACC, FAHA5; Ziyad M. Hijazi, MD, MPH, MSCAI, FACC, FAAP7; Eric Horlick, MDCM, FRCPC, FSCAI9; Bonnie H. Weiner, MD, MSEC, MBA, MSCAI10; Evan Zahn, MD, FACC, FSCAI12; Joaquin E. Cigarroa, MD, FACC13; Carlos E. Ruiz, MD, PhD, MSCAI14; Joseph Bavaria, MD15; Michael J. Mack, MD16; Duke E. Cameron, MD17; R. Morton Bolman, MD18; D. Craig Miller, MD19; Marc R. Moon, MD21; Debabrata Mukherjee, MD, FACC22; Alfredo Trento, MD23; Gabriel S. Aldea, MD24; Emile A. Bacha, MD

Preamble: The granting of staff privileges to physicians is an important mechanism to ensure quality care. The Joint Commission requires that medical staff privileges be based on professional criteria specified in medical staff bylaws. Physicians are charged with defining the criteria that constitute professional competence and with evaluating their peers accordingly. With the evolution of transcatheter valve therapy, an important opportunity arises for both cardiologists and surgeons to come together to identify the criteria for performing these procedures. The Society for Cardiovascular Angiography and Interventions (SCAI), American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), and The Society for Thoracic Surgeons (STS) have therefore joined together to provide recommendations for institutions to assess their potential for instituting and/or maintaining a transcatheter valve program. Since transcatheter valve therapy is in its infancy, there are few data upon which to base these recommendations. Therefore, many are based on expert consensus. As the procedures evolve, technology changes, experience grows, and more data accumulate, there will certainly be a need to update these recommendations. However, with the FDA having just approved these devices, the writing committee and participating societies believe that the recommendations listed in this report serve as an appropriate starting point. Since there is a strong consensus that these new valve therapies are best performed using a team approach, these credentialing criteria may be best applied at the institutional level.

01 noviembre 2014

JACC. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons

Stephan D. Fihn, MD, MPH; James C. Blankenship, MD, MHCM, MACC, FAHA; Karen P. Alexander, MD, FACC, FAHA; John A. Bittl, MD, FACC; John G. Byrne, MD, FACC; Barbara J. Fletcher, RN, MN, FAHA; Gregg C. Fonarow, MD, FACC, FAHA; Richard A. Lange, MD, FACC, FAHA; Glenn N. Levine, MD, FACC, FAHA; Thomas M. Maddox, MD, MSc, FACC, FAHA; Srihari S. Naidu, MD, FACC, FAHA, FSCAI; E. Magnus Ohman, MD, FACC; Peter K. Smith, MD, FACC

Keeping pace with emerging evidence is an ongoing challenge to timely development of clinical practice guidelines. In an effort to respond promptly to new evidence, the American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines (Task Force) has created a “focused update” process to revise the existing guideline recommendations that are affected by evolving data or opinion. New evidence is reviewed in an ongoing manner to respond quickly to important scientific and treatment trends that could have a major impact on patient outcomes and quality of care. Evidence is reviewed at least twice a year, and updates are initiated on an as-needed basis and completed as quickly as possible while maintaining the rigorous methodology that the ACC and AHA have developed during their partnership of >20 years.

01 diciembre 2014

JACC. Implications of the 2013 ACC/AHA Cholesterol Guidelines for Adults in Contemporary Cardiovascular Practice. Insights From the NCDR PINNACLE Registry

Thomas M. Maddox, MD, MSc∗; William B. Borden, MD‡; Fengming Tang, MS§; Salim S. Virani, MD, PhD‖; William J. Oetgen, MD, MBA¶; J. Brendan Mullen, BSFS#; Paul S. Chan, MD, MSc§; Paul N. Casale, MD∗∗; Pamela S. Douglas, MD††; Fredrick A. Masoudi, MD, MSPH∗; Steven A. Farmer, MD, PhD‡; John S. Rumsfeld, MD, PhD∗

Background: In a significant update, the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines recommend fixed-dose statin therapy for those at risk and do not recommend nonstatin therapies or treatment to target low-density lipoprotein cholesterol (LDL-C) levels, limiting the need for repeated LDL-C testing.

01 diciembre 2014

JACC. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Lee A. Fleisher, MD, FACC, FAHA; Kirsten E. Fleischmann, MD, MPH, FACC; Andrew D. Auerbach, MD, MPH; Susan A. Barnason, PhD, RN, FAHA; Joshua A. Beckman, MD, FACC, FAHA, FSVM; Biykem Bozkurt, MD, PhD, FACC, FAHA; Victor G. Davila-Roman, MD, FACC, FASE; Marie D. Gerhard-Herman, MD; Thomas A. Holly, MD, FACC, FASNC; Garvan C. Kane, MD, PhD, FAHA, FASE; Joseph E. Marine, MD, FACC, FHRS; M. Timothy Nelson, MD, FACS; Crystal C. Spencer, JD; Annemarie Thompson, MD; Henry H. Ting, MD, MBA, FACC, FAHA; Barry F. Uretsky, MD, FACC, FAHA, FSCAI; Duminda N. Wijeysundera, MD, PhD

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 diciembre 2014

JACC. Perioperative Beta Blockade in Noncardiac Surgery: A Systematic Review for the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Duminda N. Wijeysundera, MD, PhD; Dallas Duncan, MD, MHSc; Chileshe Nkonde-Price, MD, MS; Salim S. Virani, MD, PhD, FACC, FAHA; Jeffrey B. Washam, PharmD, FAHA; Kirsten E. Fleischmann, MD, MPH, FACC; Lee A. Fleisher, MD, FACC, FAHA

Objective: To review the literature systematically to determine whether initiation of beta blockade within 45 days prior to noncardiac surgery reduces 30-day cardiovascular morbidity and mortality rates.

01 diciembre 2013

JACC. International Expert Consensus Statement. Percutaneous Transluminal Renal Denervation for the Treatment of Resistant Hypertension

Markus P. Schlaich, MD∗; Roland E. Schmieder, MD†; George Bakris, MD‡; Peter J. Blankestijn, MD, PhD§; Michael Böhm, MD‖; Vito M. Campese, MD¶; Darrel P. Francis, MB, BChir, MA, MD#; Guido Grassi, MD∗∗; Dagmara Hering, MD, PhD∗; Richard Katholi, MD††; Sverre Kjeldsen, MD‡‡; Henry Krum, MBBS, PhD§§; Felix Mahfoud, MD‖; Giuseppe Mancia, MD∗∗; Franz H. Messerli, MD‖‖; Krzysztof Narkiewicz, MD, PhD¶¶; Gianfranco Parati, MD##; Krishna J. Rocha-Singh, MD††; Luis M. Ruilope, MD, PhD†††; Lars C. Rump, MD‡‡‡; Domenic A. Sica, MD§§§; Paul A. Sobotka, MD‖‖‖; Costas Tsioufis, MD¶¶¶; Oliver Vonend, MD‡‡‡; Michael A. Weber, MD###; Bryan Williams, MD∗∗∗∗; Thomas Zeller, MD††††; Murray D. Esler, MBBS, PhD∗

Abstract: Catheter-based radiofrequency ablation technology to disrupt both efferent and afferent renal nerves has recently been introduced to clinical medicine after the demonstration of significant systolic and diastolic blood pressure reductions. Clinical trial data available thus far have been obtained primarily in patients with resistant hypertension, defined as standardized systolic clinic blood pressure ≥160 mm Hg (or ≥150 mm Hg in patients with type 2 diabetes) despite appropriate pharmacologic treatment with at least 3 antihypertensive drugs, including a diuretic agent. Accordingly, these criteria and blood pressure thresholds should be borne in mind when selecting patients for renal nerve ablation. Secondary forms of hypertension and pseudoresistance, such as nonadherence to medication, intolerance of medication, and white coat hypertension, should have been ruled out, and 24-h ambulatory blood pressure monitoring is mandatory in this context. Because there are theoretical concerns with regard to renal safety, selected patients should have preserved renal function, with an estimated glomerular filtration rate ≥45 ml/min/1.73 m2. Optimal periprocedural management of volume status and medication regimens at specialized and experienced centers equipped with adequate infrastructure to cope with potential procedural complications will minimize potential patient risks. Long-term safety and efficacy data are limited to 3 years of follow-up in small patient cohorts, so efforts to monitor treated patients are crucial to define the long-term performance of the procedure. Although renal nerve ablation could have beneficial effects in other conditions characterized by elevated renal sympathetic nerve activity, its potential use for such indications should currently be limited to formal research studies of its safety and efficacy.

30 agosto 2014

EUROPEAN HEART JOURNAL. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolismThe Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)Endorsed by the European Respiratory Society (ERS)

Stavros Konstantinides, Adam Torbicki, Giancarlo Agnelli, Nicolas Danchin, David Fitzmaurice, Nazzareno Galiè, J. Simon R. Gibbs, Menno 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

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 revascularizationThe Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular …

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

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.