Seeking More Time with Synchrony Stevenson, Lynne Warner; Montgomery, Jay A
The New England journal of medicine,
2024-Jan-18, Volume:
390, Issue:
3
Journal Article
Table of Contents Preamble777 Introduction779 Methodology and Evidence Review779 Organization of the Writing Group779 Document Review and Approval779 Initial and Serial Evaluation of the HF ...Patient780 Biomarkers780 Biomarkers for Prevention: Recommendation781 Biomarkers for Diagnosis: Recommendation782 Biomarkers for Prognosis or Added Risk Stratification: Recommendations782 Treatment of Stages A to D784 Stage C784 Pharmacological Treatment for Stage C HF With Reduced Ejection Fraction: Recommendations784 Renin-Angiotensin System Inhibition With Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker or ARNI: Recommendation791 Treating Hypertension in Stage C HFrEF: Recommendation791 Treating Hypertension in Stage C HFpEF: Recommendation791 Sleep-Disordered Breathing: Recommendations792 References793 Appendix 1 Author Relationships With Industry and Other Entities (Relevant)798 Appendix 2 Reviewer Relationships With Industry and Other Entities (Comprehensive)800 Appendix 3 Abbreviations803 Preamble Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials, J Hypertens, Vol. 34, 2016, 613-622 191 J.T. Wright Jr., J.D. Williamson, P.K. Whelton, A Randomized Trial of Intensive versus Standard Blood-Pressure Control, N Engl J Med, Vol. 373, 2015, 2103-2116 192 J.D. Williamson, M.A. Supiano, W.B. Applegate, JAMA, Vol. 315, 2016, 2673-2682 193 J. Lv, P. Ehteshami, M.J. Sarnak, Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis, CMAJ, Vol. 185, 2013, 949-957 194 Deleted in press. 195 W.S. Aronow, J.L...
The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ...ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.
A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
The current classification of patients with New York Heart Association Class IV symptoms does not offer adequate description to allow optimal selection of patients for the current options of medical ...and pacing therapies, cardiac transplantation and mechanical circulatory support.
Seven clinical profiles and an arrhythmia modifier were developed and implemented into the first year of data collection for the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). The INTERMACS Coordinators' Council provided ongoing feedback regarding the characterization of patients receiving implantable devices.
The definition of 7 clinical profiles revealed that 80% of current devices are being used in the 2 profiles with the highest levels of clinical compromise. The INTERMACS Coordinators' Council helped to identify gaps in the characterization of hospitalized patients on temporary assist devices and of homebound patients with resting symptoms, which has led to revised definitions of Profile 3 and 4 and the addition of 2 new modifiers, for temporary circulatory support devices in the hospital, and for frequent rehospitalization of patients at home.
Patients considered for mechanical circulatory support can now be classified using the 7 profiles plus 3 modifiers developed through INTERMACS. Further understanding these profiles and their impact on outcome should help to better select patients and therapies in the advanced stages of disease.
A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure ...Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Technical Panel Steven R. Bailey, MD, FACC, FSCAI, FAHA, Moderator Andrea M. Russo, MD, FACC, FHRS, Writing Group Liaison* Suraj Kapa, MD, Writing Group Liaison Michael B. Alexander, MD, FACC§Health Plan Representative Steven R. Bailey, MD, FACC, FSCAI, FAHA||American College of Cardiology Foundation Representative Ulrika Birgersdotter-Green, MD, FHRS|| Alan S. Brown, MD, FACC, FAHA, FNLA|| Richard A. Grimm, DO, FACC, FASE¶American Society of Echocardiography Representative Paul J. Hauptman, MD#Heart Failure Society of America Representative Sharon A. Hunt, MD, FACC# Rachel Lampert, MD, FACC, FHRS* JoAnn Lindenfeld, MD, FACC**American Heart Association Representative David J. Malenka, MD, FACC|| Kartik Mani, MDdaggerdaggerSociety for Cardiovascular Angiography and Interventions Representative Joseph E. Marine, MD, FACC, FHRS* Edward T. Martin, MD, FACC, FACP, FAHAdouble daggerdouble daggerSociety for Cardiovascular Magnetic Resonance Representative Richard L. Page, MD, FACC, FHRS, FAHA|| Michael W. Rich, MD, FACC§§American Geriatrics Society Representative Paul D. Varosy, MD, FACC, FHRS* Mary Norine Walsh, MD, FACC|| Appropriate Use Criteria Task Force Michael J. Wolk, MD, MACC, Chair Steven R. Bailey, MD, FACC, FSCAI, FAHA John U. Doherty, MD, FACC Pamela S. Douglas, MD, MACC, FAHA Robert C. Hendel, MD, FACC, FAHA, FASNC Christopher M. Kramer, MD, FACC James K. Min, MD, FACC Manesh R. Patel, MD, FACC Leslee Shaw, PhD, FACC, FASNC Raymond F. Stainback, MD, FACC, FASE Joseph M. Allen, MA Table of Contents Abstract... Special Conditions/Comorbidities in Patients for Primary Prevention (Meeting Indications of ICD Implant Related to HF Diagnosis With LVEF <=30% on Guideline-Directed Medical Therapy >3 Months)... .\n Groeneveld None None None None None None Stephen Hammill None None None None None None Charles A. Henrikson None None None Boston Scientific None None Michael Ho None None None None None None Mariell Jessup None None None None None None Stuart D. Katz None None None None None None Bradley P. Knight Boston Scientific Biotronik Boston Scientific Medtronic None None None None Wayne C. Levy None None None None None None Barbara Messinger-Rapport None None None None None None Gerald V. Naccarelli Medtronic None None None None None Robert M. Palmer None None None None None None Samir B. Pancholy None Medtronic None None None None Jeanne E. Poole Biotronik Boston Scientific Medtronic St. Jude Medical None None Medtronic Boston Scientific* Medtronic* St. Jude Medical* None Subha V. Raman None None None None None None Matthew R. Reynolds Medtronic None None None None None William G. Stevenson None None None None None None Cynthia M. Tracy None None None None None None Quynh A. Truong None None None St. Jude Medical* None None Paul J. Wang Boston Scientific Medtronic None None Boston Scientific* Medtronic* None None Bruce L. Wilkoff None None None None Medtronic St. Jude Medical None Appropriate Use Criteria Task Force Michael J. Wolk None None None None None None Steven R. Bailey None None None None None None John U. Doherty None None None None None None Pamela S. Douglas None None None None None None Robert C. Hendel None None None None None None Christopher M. Kramer St. Jude Medical None None None None None James K. Min None None None None None None Manesh R. Patel None None None None None None Leslee Shaw None None None None None None Raymond F. Stainback None None None None None None Joseph M. Allen None None None None None None * This table represents the relevant relationships with industry and other entities that were disclosed by participants at the time of participation. A person is deemed to have a significant interest in a business if the interest represents ownership of 5% or more of the voting stock or share of the business entity, or ownership of $10,000 or more of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person's gross income for the previous year.
Mitral regurgitation (MR) is a complex valve lesion that can pose significant management challenges for the cardiovascular clinician. This Expert Consensus Document emphasizes that recognition of MR ...should prompt an assessment of its etiology, mechanism, and severity, as well as indications for treatment. A structured approach to evaluation based on clinical findings, precise echocardiographic imaging, and when necessary, adjunctive testing, can help clarify decision making. Treatment goals include timely intervention by an experienced heart team to prevent left ventricular dysfunction, heart failure, reduced quality of life, and premature death.
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