Actions – Guideline Analytics

Conditional actions, verbs, and deontics as captured by GEM Cutter. See filtered version for SNOMED codes.
Guideline Title	ID	Conditional	Action	Verb	Deontic
Heart Failure 2017 ACC/AHA/HFSA	32470	A thorough history and physical examination should be obtained/ performed in patients presenting with Heart Failure to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of Heart Failure.	A thorough history and physical examination should be obtained or performed	obtain	should
Heart Failure 2017 ACC/AHA/HFSA	32471	In patients with idiopathic dilated cardiomyopathy (DCM), a 3-generational family history should be obtained to aid in establishing the diagnosis of familial DCM.	a 3-generational family history should be obtained	obtain	should
Heart Failure 2017 ACC/AHA/HFSA	32472	Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of jugular venous pressure and the presence of peripheral edema or orthopnea.	assess volume status	assess	should
Heart Failure 2017 ACC/AHA/HFSA	32472	Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of jugular venous pressure and the presence of peripheral edema or orthopnea.	assess vital signs	assess	should
Heart Failure 2017 ACC/AHA/HFSA	32472	Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of jugular venous pressure and the presence of peripheral edema or orthopnea.	assess weight	assess	should
Heart Failure 2017 ACC/AHA/HFSA	32472	Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of jugular venous pressure and the presence of peripheral edema or orthopnea.	estimate jugular venous pressure	estimate	should
Heart Failure 2017 ACC/AHA/HFSA	32472	Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of jugular venous pressure and the presence of peripheral edema or orthopnea.	assess the presence of peripheral edema or orthopnea	assess	should
Heart Failure 2017 ACC/AHA/HFSA	32473	Validated multivariable risk scores can be useful to estimate subsequent risk of mortality in ambulatory or hospitalized patients with Heart Failure.	obtain validated multivariable risk scores	obtain
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform complete blood cell count,	perform	should
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform urinalysis	perform	should
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform measurement of serum electrolytes (including calcium and magnesium),	perform	should
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform measurement of blood urea nitrogen	perform
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform measurement of serum creatinine	perform
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform measurement of glucose,	perform
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform measurement of thyroid-stimulating hormone	perform
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform a fasting lipid profile test	perform
Heart Failure 2017 ACC/AHA/HFSA	32474	Initial laboratory evaluation of patients presenting with Heart Failure should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests.	perform liver function tests	perform
Heart Failure 2017 ACC/AHA/HFSA	32475	Serial monitoring, when indicated, should include serum electrolyte levels and renal function.	include serum electrolyte levels and renal function	include	should
Heart Failure 2017 ACC/AHA/HFSA	32476	A 12-lead electrocardiogram should be performed initially on all patients presenting with Heart Failure	12-lead electrocardiogram should be performed initially	perform	should
Heart Failure 2017 ACC/AHA/HFSA	32477	Screening for hemochromatosis or HIV is reasonable in selected patients who present with Heart Failure.	Screening for hemochromatosis or HIV is reasonable	screen	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32478	Diagnostic tests for rheumatological diseases, amyloidosis, or pheochromocytoma are reasonable in patients presenting with Heart Failure in whom there is a clinical suspicion of these diseases.	perform diagnostic tests for rheumatological diseases	perform
Heart Failure 2017 ACC/AHA/HFSA	32478	Diagnostic tests for rheumatological diseases, amyloidosis, or pheochromocytoma are reasonable in patients presenting with Heart Failure in whom there is a clinical suspicion of these diseases.	perform diagnostic tests for amyloidosis	perform
Heart Failure 2017 ACC/AHA/HFSA	32478	Diagnostic tests for rheumatological diseases, amyloidosis, or pheochromocytoma are reasonable in patients presenting with Heart Failure in whom there is a clinical suspicion of these diseases.	perform diagnostic tests for pheochromocytoma	perform
Heart Failure 2017 ACC/AHA/HFSA	32479	For patients at risk of developing Heart Failure, natriuretic peptide biomarker–based screening followed by team-based care, including a cardiovascular specialist optimizing GDMT, can be useful to prevent the development of left ventricular dysfunction (systolic or diastolic) or new-onset Heart Failure.	perform natriuretic peptide biomarker–based screening	screen	can be useful
Heart Failure 2017 ACC/AHA/HFSA	32479	For patients at risk of developing Heart Failure, natriuretic peptide biomarker–based screening followed by team-based care, including a cardiovascular specialist optimizing GDMT, can be useful to prevent the development of left ventricular dysfunction (systolic or diastolic) or new-onset Heart Failure.	perform team-based care, including a cardiovascular specialist optimizing GDMT	perform
Heart Failure 2017 ACC/AHA/HFSA	32480	In patients presenting with dyspnea, measurement of natriuretic peptide biomarkers is useful to support a diagnosis or exclusion of Heart Failure.	perform measurement of natriuretic peptide biomarkers	measure	useful
Heart Failure 2017 ACC/AHA/HFSA	32481	Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic Heart Failure.	perform measurement of BNP or NT-proBNP	perform measurement	useful
Heart Failure 2017 ACC/AHA/HFSA	32482	Measurement of baseline levels of natriuretic peptide biomarkers and/or cardiac troponin on admission to the hospital is useful to establish a prognosis in acutely decompensated Heart Failure.	perform measurement of baseline levels of natriuretic peptide biomarkers and/or cardiac troponin	perform measurement	useful
Heart Failure 2017 ACC/AHA/HFSA	32483	During a Heart Failure hospitalization, a predischarge natriuretic peptide level can be useful to establish a postdischarge prognosis.	perform a measurement of predischarge natriuretic peptide level	perform measurement	useful
Heart Failure 2017 ACC/AHA/HFSA	32484	In patients with chronic Heart Failure, measurement of other clinically available tests, such as biomarkers of myocardial injury or fibrosis, may be considered for additive risk stratification.	perform measurement of clinically available tests, such as biomarkers of myocardial injury or fibrosis	perform measurement	may consider
Heart Failure 2017 ACC/AHA/HFSA	32485	Patients with suspected or new-onset Heart Failure, or those presenting with acute decompensated Heart Failure, should undergo a chest x-ray to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient’s symptoms.	undergo a chest x-ray		should
Heart Failure 2017 ACC/AHA/HFSA	32486	A 2-dimensional echocardiogram with Doppler should be performed during initial evaluation of patients presenting with Heart Failure to assess ventricular function, size, wall thickness, wall motion, and valve function.	perform a 2-dimensional echocardiogram with Doppler	perform	should be
Heart Failure 2017 ACC/AHA/HFSA	32487	Repeat measurement of EF and measurement of the severity of structural remodeling are useful to provide information in patients with Heart Failure who have had a significant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a significant effect on cardiac function; or who may be candidates for device therapy.	repeat measurement of EF	perform	useful
Heart Failure 2017 ACC/AHA/HFSA	32487	Repeat measurement of EF and measurement of the severity of structural remodeling are useful to provide information in patients with Heart Failure who have had a significant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a significant effect on cardiac function; or who may be candidates for device therapy.	measurement of the severity of structural remodeling	perform	useful
Heart Failure 2017 ACC/AHA/HFSA	32489	Viability assessment is reasonable in select situations when planning revascularization in Heart Failure patients with CAD.	Viability assessment		reasonable
Heart Failure 2017 ACC/AHA/HFSA	32490	Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate.	Radionuclide ventriculography	perform	useful
Heart Failure 2017 ACC/AHA/HFSA	32490	Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate.	magnetic resonance imaging	perform	useful
Heart Failure 2017 ACC/AHA/HFSA	32491	Magnetic resonance imaging is reasonable when assessing myocardial infiltrative processes or scar burden.	Magnetic resonance imaging	perform	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32492	Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should NOT be performed.	perform routine repeat measurement of LV function assessment	perform	should not
Heart Failure 2017 ACC/AHA/HFSA	32493	Invasive hemodynamic monitoring with a pulmonary artery catheter should be performed to guide therapy in patients who have respiratory distress or clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment.	Invasive hemodynamic monitoring with a pulmonary artery catheter	perform	should
Heart Failure 2017 ACC/AHA/HFSA	32494	Invasive hemodynamic monitoring can be useful for carefully selected patients with acute Heart Failure who have persistent symptoms despite empiric adjustment of standard therapies, and: • Whose fluid status, perfusion, or systemic or pulmonary vascular resistance is uncertain; • Whose systolic pressure remains low, or is associated with symptoms, despite initial therapy; • Whose renal function is worsening with therapy; • Who require parenteral vasoactive agents; or • Who may need consideration for mechanical circulatory support (MCS) or transplantation.	Invasive hemodynamic monitoring		can be useful
Heart Failure 2017 ACC/AHA/HFSA	32495	When ischemia may be contributing to Heart Failure, coronary arteriography is reasonable for patients eligible for revascularization.	coronary arteriography	perform	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32496	Endomyocardial biopsy can be useful in patients presenting with Heart Failure when a specific diagnosis is suspected that would influence therapy.	Endomyocardial biopsy	perform	can be useful
Heart Failure 2017 ACC/AHA/HFSA	32497	Routine use of invasive hemodynamic monitoring is NOT recommended in normotensive patients with acute decompensated Heart Failure and congestion with symptomatic response to diuretics and vasodilators.	Routine use of invasive hemodynamic monitoring	perform	NOT recommended
Heart Failure 2017 ACC/AHA/HFSA	32498	Endomyocardial biopsy should NOT be performed in the routine evaluation of patients with Heart Failure.	Endomyocardial biopsy		should not
Heart Failure 2017 ACC/AHA/HFSA	32499	Hypertension and lipid disorders should be controlled in accordance with contemporary guidelines to lower the risk of Heart Failure.	control hypertension
Heart Failure 2017 ACC/AHA/HFSA	32499	Hypertension and lipid disorders should be controlled in accordance with contemporary guidelines to lower the risk of Heart Failure.	control lipid disorders
Heart Failure 2017 ACC/AHA/HFSA	32500	Other conditions that may lead to or contribute to Heart Failure, such as obesity, diabetes mellitus, tobacco use, and known cardiotoxic agents, should be controlled or avoided.	controlled	control condition	should
Heart Failure 2017 ACC/AHA/HFSA	32500	Other conditions that may lead to or contribute to Heart Failure, such as obesity, diabetes mellitus, tobacco use, and known cardiotoxic agents, should be controlled or avoided.	avoided
Heart Failure 2017 ACC/AHA/HFSA	32501	In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, angiotensin-converting enzyme (ACE) inhibitors should be used to prevent symptomatic Heart Failure and reduce mortality. In patients intolerant of ACE inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated.	angiotensin-converting enzyme (ACE) inhibitors should be used
Heart Failure 2017 ACC/AHA/HFSA	32502	In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, angiotensin-converting enzyme (ACE) inhibitors should be used to prevent symptomatic Heart Failure and reduce mortality. In patients intolerant of ACE inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated.	angiotensin-converting enzyme (ACE) inhibitors should be used
Heart Failure 2017 ACC/AHA/HFSA	32501	In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, angiotensin-converting enzyme (ACE) inhibitors should be used to prevent symptomatic Heart Failure and reduce mortality. In patients intolerant of ACE inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated.	angiotensin-receptor blockers are appropriate unless contraindicated	use
Heart Failure 2017 ACC/AHA/HFSA	32502	In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, angiotensin-converting enzyme (ACE) inhibitors should be used to prevent symptomatic Heart Failure and reduce mortality. In patients intolerant of ACE inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated.	angiotensin-receptor blockers are appropriate unless contraindicated	use
Heart Failure 2017 ACC/AHA/HFSA	32503	In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, evidence-based beta blockers should be used to reduce mortality.	evidence-based beta blockers should be used to reduce mortality	use	should
Heart Failure 2017 ACC/AHA/HFSA	32504	In all patients with a recent or remote history of MI or acute coronary syndrome, statins should be used to prevent symptomatic Heart Failure and cardiovascular events.	statins should be used to prevent symptomatic HF and cardiovascular events.	use	should
Heart Failure 2017 ACC/AHA/HFSA	32505	In patients with structural cardiac abnormalities, including LV hypertrophy, in the absence of a history of MI or ACS, blood pressure should be controlled in accordance with clinical practice guidelines for hypertension to prevent symptomatic Heart Failure.	blood pressure should be controlled in accordance with clinical practice guidelines for hypertension to prevent symptomatic HF.	control	should
Heart Failure 2017 ACC/AHA/HFSA	32506	ACE inhibitors should be used in all patients with a reduced EF to prevent symptomatic Heart Failure, even if they do not have a history of MI.	ACE inhibitors should be used
Heart Failure 2017 ACC/AHA/HFSA	32507	Beta blockers should be used in all patients with a reduced EF to prevent symptomatic Heart Failure, even if they do not have a history of MI.	Beta blockers should be used
Heart Failure 2017 ACC/AHA/HFSA	32508	To prevent sudden death, placement of an implantable cardioverterdefibrillator (ICD) is reasonable in patients with asymptomatic ischemic cardiomyopathy who are ?40 days post-MI, have an LVEF of ?30%, are on appropriate medical therapy, and have a reasonable expectation of survival with a good functional status for >1 year.	placement of an implantable cardioverterdefibrillator (ICD) is reasonable	implant	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32509	Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of Heart Failure after MI.	Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful	treat	may
Heart Failure 2017 ACC/AHA/HFSA	32510	Patients with Heart Failure should receive specific education to facilitate Heart Failure self-care.	should receive specific education to facilitate HF self-care	educate	should
Heart Failure 2017 ACC/AHA/HFSA	32511	Sodium restriction is reasonable for patients with symptomatic Heart Failure to reduce congestive symptoms.	Sodium restriction is reasonable	restrict	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32512	Exercise training (or regular physical activity) is recommended as safe and effective for patients with Heart Failure who are able to participate to improve functional status.	Exercise training (or regular physical activity) is recommended as safe and effective	advise	recommended
Heart Failure 2017 ACC/AHA/HFSA	32513	Cardiac rehabilitation can be useful in clinically stable patients with Heart Failure to improve functional capacity, exercise duration, health-related quality of life (HRQOL), and mortality.	Cardiac rehabilitation can be useful	use	can
Heart Failure 2017 ACC/AHA/HFSA	32514	Measures listed as Class I recommendations for patients in stages A and B are recommended where appropriate for patients in stage C. (I-A, I-B, and I-C as appropriate)	use same measures listed in Class I recommendations for patients in stages A and B
Heart Failure 2017 ACC/AHA/HFSA	32516	Heart FailurerEF NYHA class I?IV (Stage C) ACEI or ARB AND GDMT beta blocker; diuretics as needed (COR I)	treat with angiotensin-converting enzyme inhibitor or angiotensin receptor-blocker
Heart Failure 2017 ACC/AHA/HFSA	32516	Heart FailurerEF NYHA class I?IV (Stage C) ACEI or ARB AND GDMT beta blocker; diuretics as needed (COR I)	GDMT beta blocker;
Heart Failure 2017 ACC/AHA/HFSA	32516	Heart FailurerEF NYHA class I?IV (Stage C) ACEI or ARB AND GDMT beta blocker; diuretics as needed (COR I)	diuretics as needed
Heart Failure 2017 ACC/AHA/HFSA	32517	NYHA class II?IV, provided est. CrCl >30 mL/min & K+ <5.0 mEq/L implement Aldosterone antagonist (COR I)	implement aldosterone antagonist
Heart Failure 2017 ACC/AHA/HFSA	32518	NYHA class II?III Heart Failure Adequate BP on ACEI or ARB; No C/I to ARB or sacubitril then Discontinue ACEI or ARB; initiate ARNI	Discontinue ACEI or ARB
Heart Failure 2017 ACC/AHA/HFSA	32518	NYHA class II?III Heart Failure Adequate BP on ACEI or ARB; No C/I to ARB or sacubitril then Discontinue ACEI or ARB; initiate ARNI	initiate ARNI
Heart Failure 2017 ACC/AHA/HFSA	32519	NYHA class III?IV, in black patients implment Hydral-Nitrates	implement Hydral-Nitrates
Heart Failure 2017 ACC/AHA/HFSA	32520	NYHA class II?III, LVEF ?35%; (caveat: >1 y survival, >40 d post MI) implement implantable cardioverter-defibrillator	implement implantable cardioverter defibrillator
Heart Failure 2017 ACC/AHA/HFSA	32521	NYHA class II?IV, LVEF ?35%, NSR & QRS ?150 ms with LBBB pattern	implement cardiac resynchronization therapy
Heart Failure 2017 ACC/AHA/HFSA	32521	NYHA class II?IV, LVEF ?35%, NSR & QRS ?150 ms with LBBB pattern	implement cardiac resynchronization therapy–device
Heart Failure 2017 ACC/AHA/HFSA	32522	NYHA class II?III, NSR, heart rate ?70 bpm on maximally tolerated dose beta blocker	implement Ivabradine
Heart Failure 2017 ACC/AHA/HFSA	32523	patients are Stage D refractory NYHA class III-IV consider additional therapy of palliative care (COR I) or transplant (COR I) or left ventricular assist device (COR IIa) or Investigational studies	consider additional therapy of palliative care (COR I)
Heart Failure 2017 ACC/AHA/HFSA	32523	patients are Stage D refractory NYHA class III-IV consider additional therapy of palliative care (COR I) or transplant (COR I) or left ventricular assist device (COR IIa) or Investigational studies	consider additional therapy of transplant (COR I)
Heart Failure 2017 ACC/AHA/HFSA	32523	patients are Stage D refractory NYHA class III-IV consider additional therapy of palliative care (COR I) or transplant (COR I) or left ventricular assist device (COR IIa) or Investigational studies	consider additional therapy of left ventricular assist device (COR IIa)
Heart Failure 2017 ACC/AHA/HFSA	32523	patients are Stage D refractory NYHA class III-IV consider additional therapy of palliative care (COR I) or transplant (COR I) or left ventricular assist device (COR IIa) or Investigational studies	consider investigational studies
Heart Failure 2017 ACC/AHA/HFSA	32524	Diuretics are recommended in patients with Heart FailurerEF with fluid retention	Diuretics are recommended	use	recommend
Heart Failure 2017 ACC/AHA/HFSA	32525	ACE inhibitors are recommended for all patients with Heart FailurerEF	ACE inhibitors are recommended	use	recommend
Heart Failure 2017 ACC/AHA/HFSA	32526	ARBs are recommended in patients with Heart FailurerEF who are ACE inhibitor–intolerant	ARBs are recommended	use	recommend
Heart Failure 2017 ACC/AHA/HFSA	32527	ARBs are reasonable as alternatives to ACE inhibitors as first-line therapy in Heart FailurerEF	ARBs are reasonable as alternatives to ACE inhibitors
Heart Failure 2017 ACC/AHA/HFSA	32528	Addition of an ARB may be considered in persistently symptomatic patients with Heart FailurerEF on GDMT	Addition of an ARB may be considered	add	considered
Heart Failure 2017 ACC/AHA/HFSA	32529	Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with Heart FailurerEF.	Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful	use
Heart Failure 2017 ACC/AHA/HFSA	32530	Use of 1 of the 3 beta blockers proven to reduce mortality is recommended for all stable patients	Use of 1 of the 3 beta blockers proven to reduce mortality is recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32531	Aldosterone receptor antagonists are recommended in patients with NYHA class II–IV Heart Failure who have LVEF ?35%	Aldosterone receptor antagonists are recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32532	Aldosterone receptor antagonists are recommended to reduce morbidity and mortality following an acute MI in patients who have LVEF of ?40% who develop symptoms of Heart Failure or who have a history of diabetes mellitus, unless contraindicated.	Aldosterone receptor antagonists are recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32533	Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is >2.5 mg/dL in men or >2.0 mg/dL in women (or estimated glomerular filtration rate <30 mL/min/1.73 m2), and/or potassium >5.0 mEq/L.	Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency
Heart Failure 2017 ACC/AHA/HFSA	32534	The combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III–IV Heart FailurerEF on GDMT	combination of hydralazine and isosorbide dinitrate is recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32535	A combination of hydralazine and isosorbide dinitrate can be useful in patients with Heart FailurerEF who cannot be given ACE inhibitors or ARBs	A combination of hydralazine and isosorbide dinitrate can be useful	use	can
Heart Failure 2017 ACC/AHA/HFSA	32536	Digoxin can be beneficial in patients with Heart FailurerEF, unless contraindicated, to decrease hospitalizations for Heart Failure.	Digoxin can be beneficial, unless contraindicated
Heart Failure 2017 ACC/AHA/HFSA	32537	Patients with chronic Heart Failure with permanent/persistent/paroxysmal AF and an additional risk factor for cardioembolic stroke (history of hypertension, diabetes mellitus, previous stroke or transient ischemic attack, or ?75 years of age) should receive chronic anticoagulant therapy (in the absence of contraindications to anticoagulation).	should receive chronic anticoagulant therapy	treat	should
Heart Failure 2017 ACC/AHA/HFSA	32538	The selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. (	The selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) should be individualized	individualize	should
Heart Failure 2017 ACC/AHA/HFSA	32539	Chronic anticoagulation is reasonable for patients with chronic Heart Failure who have permanent/persistent/paroxysmal AF but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). (	Chronic anticoagulation is reasonable		reasonable
Heart Failure 2017 ACC/AHA/HFSA	32540	Anticoagulation is NOT recommended in patients with chronic Heart FailurerEF without AF, a prior thromboembolic event, or a cardioembolic source	Anticoagulation	perform	recommended
Heart Failure 2017 ACC/AHA/HFSA	32541	Statins are NOT beneficial as adjunctive therapy when prescribed solely for Heart Failure	Statins are NOT beneficial as adjunctive therapy	use
Heart Failure 2017 ACC/AHA/HFSA	32542	Omega-3 PUFA supplementation is reasonable to use as adjunctive therapy in Heart FailurerEF or Heart FailurepEF patients	Omega-3 PUFA supplementation is reasonable to use as adjunctive therapy	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32543	Nutritional supplements as treatment for Heart Failure are NOT recommended in patients with current or prior symptoms of Heart FailurerEF. (	Nutritional supplements as treatment for HF are NOT recommended	treat	recommended
Heart Failure 2017 ACC/AHA/HFSA	32544	Hormonal therapies other than to correct deficiencies are NOT recommended in Heart FailurerEF	Hormonal therapies other than to correct deficiencies are NOT recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32545	Drugs known to adversely affect the clinical status of patients with current or prior symptoms of Heart FailurerEF are potentially harmful and should be avoided or withdrawn whenever possible (eg, most antiarrhythmic drugs, most calcium channel–blocking drugs [except amlodipine], nonsteroidal anti-inflammatory drugs, or thiazolidinediones).	avoided or withdrawn whenever possible (eg, most antiarrhythmic drugs, most calcium channel–blocking drugs [except amlodipine], nonsteroidal anti-inflammatory drugs, or thiazolidinediones).	avoid use	should
Heart Failure 2017 ACC/AHA/HFSA	32546	Long-term use of infused positive inotropic drugs is potentially harmful for patients with Heart FailurerEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment	Long-term use of infused positive inotropic drugs is potentially harmful	use
Heart Failure 2017 ACC/AHA/HFSA	32547	Calcium channel–blocking drugs are NOT recommended as routine treatment in Heart FailurerEF	Calcium channel–blocking drugs are NOT recommended as routine treatment	treat	recommended
Heart Failure 2017 ACC/AHA/HFSA	32548	The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors OR ARBs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic Heart FailurerEF to reduce morbidity and mortality.	The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors OR ARBs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients	perform	recommend
Heart Failure 2017 ACC/AHA/HFSA	32549	The clinical strategy of inhibition of the renin-angiotensin system with ARNI in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic Heart FailurerEF to reduce morbidity and mortality.	The clinical strategy of inhibition of the renin-angiotensin system with ARNI in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients
Heart Failure 2017 ACC/AHA/HFSA	32550	The use of ACE inhibitors is beneficial for patients with prior or current symptoms of chronic Heart FailurerEF to reduce morbidity and mortality.	The use of ACE inhibitors is beneficial	use
Heart Failure 2017 ACC/AHA/HFSA	32551	The use of ARBs to reduce morbidity and mortality is recommended in patients with prior or current symptoms of chronic Heart FailurerEF who are intolerant to ACE inhibitors because of cough or angioedema.	The use of ARBs to reduce morbidity and mortality is recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32552	In patients with chronic symptomatic Heart FailurerEF NYHA class II or III who tolerate an ACE inhibitor or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality.	replacement by an ARNI is recommended to further reduce morbidity and mortality.	replace	recommended
Heart Failure 2017 ACC/AHA/HFSA	32553	Angiotensin receptor-neprilysin inhibitor should not be administered concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor.	Angiotensin receptor-neprilysin inhibitor should not be administered concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor.		should
Heart Failure 2017 ACC/AHA/HFSA	32554	Angiotensin receptor-neprilysin inhibitor should not be administered to patients with a history of angioedema.	Angiotensin receptor-neprilysin inhibitor should not be administered
Heart Failure 2017 ACC/AHA/HFSA	32555	Ivabradine can be beneficial to reduce Heart Failure hospitalization for patients with symptomatic (NYHA class II-III) stable chronic Heart FailurerEF (LVEF ?35%) who are receiving GDEM, including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of ?70 bpm at rest.	Ivabradine can be beneficial to reduce HF hospitalization	use	can
Heart Failure 2017 ACC/AHA/HFSA	32556	Diuretics are recommended in patients with Heart FailurerEF who have evidence of fluid retention, unless contraindicated, to improve symptoms.	Diuretics are recommended	use	recommend
Heart Failure 2017 ACC/AHA/HFSA	32557	ACE inhibitors are recommended in patients with Heart FailurerEF and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality.	ACE inhibitors are recommended
Heart Failure 2017 ACC/AHA/HFSA	32558	ARBs are recommended in patients with Heart FailurerEF with current or prior symptoms who are ACE inhibitor–intolerant, unless contraindicated, to reduce morbidity and mortality.	ARBs are recommended	use	recommend
Heart Failure 2017 ACC/AHA/HFSA	32559	ARBs are reasonable to reduce morbidity and mortality as alternatives to ACE inhibitors as first-line therapy for patients with Heart FailurerEF, especially for patients already taking ARBs for other indications, unless contraindicated.	ARBs are reasonable to reduce morbidity and mortality as alternatives to ACE inhibitors
Heart Failure 2017 ACC/AHA/HFSA	32560	Addition of an ARB may be considered in persistently symptomatic patients with Heart FailurerEF who are already being treated with an ACE inhibitor and a beta blocker in whom an aldosterone antagonist is not indicated or tolerated.	Addition of an ARB	add	may
Heart Failure 2017 ACC/AHA/HFSA	32561	Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with Heart FailurerEF.	Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful	harm	potentially
Heart Failure 2017 ACC/AHA/HFSA	32562	Use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of Heart FailurerEF, unless contraindicated, to reduce morbidity and mortality.	Use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate)		recommend
Heart Failure 2017 ACC/AHA/HFSA	32563	Aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with NYHA class II–IV and who have LVEF of ?35%, unless contraindicated, to reduce morbidity and mortality. Patients with NYHA class II should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists. Creatinine levels should be ?2.5 mg/dL in men or ?2.0 mg/dL in women (or estimated glomerular filtration rate >30 mL/min/1.73 m2) 2) and potassium levels should be <5.0 mEq/L. Careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency.	Aldosterone receptor antagonists (or mineralocorticoid receptor antagonists)		recommended
Heart Failure 2017 ACC/AHA/HFSA	32563	Aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with NYHA class II–IV and who have LVEF of ?35%, unless contraindicated, to reduce morbidity and mortality. Patients with NYHA class II should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists. Creatinine levels should be ?2.5 mg/dL in men or ?2.0 mg/dL in women (or estimated glomerular filtration rate >30 mL/min/1.73 m2) 2) and potassium levels should be <5.0 mEq/L. Careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency.	Careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency.
Heart Failure 2017 ACC/AHA/HFSA	32564	Aldosterone receptor antagonists are recommended to reduce morbidity and mortality following an acute MI in patients who have LVEF of ?40% who develop symptoms of Heart Failure or who have a history of diabetes mellitus, unless contraindicated.	Aldosterone receptor antagonists		recommend
Heart Failure 2017 ACC/AHA/HFSA	32565	Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is >2.5 mg/dL in men or >2.0 mg/dL in women (or estimated glomerular filtration rate <30 mL/min/1.73 m2), and/or potassium >5.0 mEq/L.	Inappropriate use of aldosterone receptor antagonists is potentially harmful
Heart Failure 2017 ACC/AHA/HFSA	32566	The combination of hydralazine and isosorbide dinitrate is recommended to reduce morbidity and mortality for patients selfdescribed as African Americans with NYHA class III–IV Heart FailurerEF receiving optimal therapy with ACE inhibitors and beta blockers, unless contraindicated.	The combination of hydralazine and isosorbide dinitrate is recommended	use	recommend
Heart Failure 2017 ACC/AHA/HFSA	32567	A combination of hydralazine and isosorbide dinitrate can be useful to reduce morbidity or mortality in patients with current or prior symptomatic Heart FailurerEF who cannot be given an ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency, unless contraindicated.	A combination of hydralazine and isosorbide dinitrate can be useful	use	can
Heart Failure 2017 ACC/AHA/HFSA	32568	Digoxin can be beneficial in patients with Heart FailurerEF, unless contraindicated, to decrease hospitalizations for Heart Failure.	Digoxin can be beneficial	use	beneficial
Heart Failure 2017 ACC/AHA/HFSA	32569	Patients with chronic Heart Failure with permanent/persistent/paroxysmal AF and an additional risk factor for cardioembolic stroke (history of hypertension, diabetes mellitus, previous stroke or transient ischemic attack, or ?75 years of age) should receive chronic anticoagulant therapy (in the absence of contraindications to anticoagulation).	should receive chronic anticoagulant therapy (in the absence of contraindications to anticoagulation).
Heart Failure 2017 ACC/AHA/HFSA	32570	The selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin.	individualize the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF	individualize	should
Heart Failure 2017 ACC/AHA/HFSA	32571	Chronic anticoagulation is reasonable for patients with chronic Heart Failure who have permanent/persistent/paroxysmal AF but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation).	Chronic anticoagulation is reasonable	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32572	Anticoagulation is NOT recommended in patients with chronic Heart FailurerEF without AF, a prior thromboembolic event, or a cardioembolic source. (III-B: No Benefit)	Anticoagulation is NOT recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32573	Statins are NOT beneficial as adjunctive therapy when prescribed solely for the diagnosis of Heart Failure in the absence of other indications for their use.	Statins are NOT beneficial as adjunctive therapy
Heart Failure 2017 ACC/AHA/HFSA	32574	Omega-3 polyunsaturated fatty acid (PUFA) supplementation is reasonable to use as adjunctive therapy in patients with NYHA class II–IV symptoms and Heart FailurerEF or Heart FailurepEF, unless contraindicated, to reduce mortality and cardiovascular hospitalizations.	Omega-3 polyunsaturated fatty acid (PUFA) supplementation is reasonable to use as adjunctive therapy	supplement	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32575	Nutritional supplements as treatment for Heart Failure are NOT recommended in patients with current or prior symptoms of Heart FailurerEF.	Nutritional supplements as treatment for HF are NOT recommended
Heart Failure 2017 ACC/AHA/HFSA	32576	Hormonal therapies other than to correct deficiencies are NOT recommended for patients with current or prior symptoms of Heart FailurerEF.	Hormonal therapies other than to correct deficiencies are NOT recommended
Heart Failure 2017 ACC/AHA/HFSA	32577	Drugs known to adversely affect the clinical status of patients with current or prior symptoms of Heart FailurerEF are potentially harmful and should be avoided or withdrawn whenever possible (eg, most antiarrhythmic drugs, most calcium channel–blocking drugs [except amlodipine], nonsteroidal anti-inflammatory drugs, or thiazolidinediones).	Drugs known to adversely affect the clinical status are potentially harmful and should be avoided or withdrawn whenever possible	avoid	should
Heart Failure 2017 ACC/AHA/HFSA	32578	Long-term use of infused positive inotropic drugs is potentially harmful for patients with Heart FailurerEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage D starting on page 34).	Long-term use of infused positive inotropic drugs is potentially harmful except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment
Heart Failure 2017 ACC/AHA/HFSA	32579	Calcium channel–blocking drugs are NOT recommended as routine treatment for patients with Heart FailurerEF.	Calcium channel–blocking drugs are NOT recommended as routine treatment	prescribe	recommend
Heart Failure 2017 ACC/AHA/HFSA	32580	Systolic and diastolic blood pressure should be controlled in patients with Heart FailurepEF in accordance with published clinical practice guidelines to prevent morbidity.	Systolic and diastolic blood pressure should be controlled	control	should
Heart Failure 2017 ACC/AHA/HFSA	32581	Diuretics should be used for relief of symptoms due to volume overload in patients with Heart FailurepEF.	Diuretics should be used for relief of symptoms due to volume overload	use	should
Heart Failure 2017 ACC/AHA/HFSA	32582	Coronary revascularization is reasonable in patient with CAD in whom symptoms (angina) or demonstrable myocardial ischemia is judged to be having an adverse effect on symptomatic Heart FailurepEF despite GDMT.	Coronary revascularization is reasonable	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32583	Management of AF according to published clinical practice guidelines in patients with Heart FailurepEF is reasonable to improve symptomatic Heart Failure.	Management of AF according to published clinical practice guidelines is reasonable to improve symptomatic HF	manage	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32584	The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with Heart FailurepEF.	use beta-blocking agents	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32584	The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with Heart FailurepEF.	use ACE inhibitors	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32584	The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with Heart FailurepEF.	use ARBs	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32585	In appropriately selected patients with Heart FailurepEF (with EF ?45%, elevated BNP levels or Heart Failure admission within 1 year, estimated glomerular filtration rate >30 mL/min, creatinine <2.5 mg/dL, potassium <5.0 mEq/L), aldosterone receptor antagonists might be considered to decrease hospitalizations.	aldosterone receptor antagonists might be considered to decrease hospitalizations.	use	might
Heart Failure 2017 ACC/AHA/HFSA	32586	The use of ARBs might be considered to decrease hospitalizations for patients with Heart FailurepEF.	use of ARBs might be considered to decrease hospitalizations	use	might
Heart Failure 2017 ACC/AHA/HFSA	32587	Routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QoL in patients with Heart FailurepEF is ineffective.	Routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QoL is ineffective
Heart Failure 2017 ACC/AHA/HFSA	32588	Routine use of nutritional supplements is not recommended for patients with Heart FailurepEF.	Routine use of nutritional supplements is not recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32589	ICD therapy is recommended for primary prevention of sudden cardiac death (SCD) to reduce total mortality in selected patients with nonischemic DCM or ischemic heart disease ?40 days post-MI with LVEF of ?35% and NYHA class II or III symptoms on chronic GDMT, who have a reasonable expectation of meaningful survival for >1 year.a .a (I-A)	ICD therapy is recommended for primary prevention of sudden cardiac death to reduce total mortality
Heart Failure 2017 ACC/AHA/HFSA	32590	Cardiac resynchronization therapy is indicated for patients who have LVEF of 35% or less, sinus rhythm, left bundle-branch block (LBBB) with a QRS duration of 150 ms or greater, and NYHA class II, III, or ambulatory class IV symptoms on GDMT.	Cardiac resynchronization therapy	use
Heart Failure 2017 ACC/AHA/HFSA	32591	ICD therapy is recommended for primary prevention of SCD to reduce total mortality in selected patients at least 40 days post-MI with LVEF of 30% or less and NYHA class I symptoms while receiving GDMT, who have a reasonable expectation of meaningful survival for more than 1 year.	ICD therapy is recommended for primary prevention of SCD to reduce total mortality	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32592	CRT can be useful for patients who have LVEF of ?35% , sinus rhythm, a non-LBBB pattern with a QRS duration of ?150 ms, and NYHA class III/ambulatory class IV symptoms on GDMT.	CRT can be useful		can
Heart Failure 2017 ACC/AHA/HFSA	32593	CRT can be useful for patients who have LVEF of ?35%, sinus rhythm, LBBB with a QRS duration of 120–149 ms, and NYHA class II, III, or ambulatory class IV symptoms on GDMT.	CRT can be useful	use	can
Heart Failure 2017 ACC/AHA/HFSA	32594	CRT can be useful in patients with AF and LVEF of ?35% on GDMT if a) the patient requires ventricular pacing or otherwise meets CRT criteria and b) atrioventricular nodal ablation or pharmacological rate control will allow near 100% ventricular pacing with CRT.	CRT can be useful	use	can
Heart Failure 2017 ACC/AHA/HFSA	32595	CRT can be useful for patients on GDMT who have LVEF of ?35% and are undergoing placement of a new or replacement device with anticipated requirement for significant (>40%) ventricular pacing.	CRT can be useful
Heart Failure 2017 ACC/AHA/HFSA	32596	The usefulness of implantation of an ICD is of uncertain benefit to prolong meaningful survival in patients with a high risk of nonsudden death as predicted by frequent hospitalizations, advanced frailty, or comorbidities such as systemic malignancy or severe renal dysfunction.	The usefulness of implantation of an ICD is of uncertain benefit to prolong meaningful survival
Heart Failure 2017 ACC/AHA/HFSA	32597	CRT may be considered for patients who have LVEF of ?35%, sinus rhythm, a non-LBBB pattern with a QRS duration of 120–149 ms, and NYHA class III/ambulatory class IV on GDMT.	CRT may be considered		may
Heart Failure 2017 ACC/AHA/HFSA	32598	CRT may be considered for patients who have LVEF of ?35%, sinus rhythm, a non-LBBB pattern with a QRS duration of ?150 ms, and NYHA class II symptoms on GDMT.	CRT may be considered
Heart Failure 2017 ACC/AHA/HFSA	32599	CRT may be considered for patients who have LVEF of ?30%, ischemic etiology of Heart Failure, sinus rhythm, LBBB with a QRS duration of ?150 ms, and NYHA class I symptoms on GDMT.	CRT may be considered
Heart Failure 2017 ACC/AHA/HFSA	32600	CRT is NOT recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with a QRS duration of <150 ms.	CRT is NOT recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32601	CRT is NOT indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to <1 year.	CRT is NOT indicated
Heart Failure 2017 ACC/AHA/HFSA	32602	Fluid restriction (1.5–2 L/d) is reasonable in stage D, especially in patients with hyponatremia, to reduce congestive symptoms.	Fluid restriction (1.5–2 L/d) is reasonable to reduce congestive symptoms		reasonable
Heart Failure 2017 ACC/AHA/HFSA	32603	Until definitive therapy (eg, coronary revascularization, MCS, heart transplantation) or resolution of the acute precipitating problem, patients with cardiogenic shock should receive temporary intravenous inotropic support to maintain systemic perfusion and preserve endorgan performance.	should receive temporary intravenous inotropic support	receive	should
Heart Failure 2017 ACC/AHA/HFSA	32604	Continuous intravenous inotropic support is reasonable as “bridge therapy” in patients with stage D Heart Failure refractory to GDMT and device therapy who are eligible for and awaiting MCS or cardiac transplantation.	Continuous intravenous inotropic support is reasonable as “bridge therapy”
Heart Failure 2017 ACC/AHA/HFSA	32605	Short-term, continuous intravenous inotropic support may be reasonable in those hospitalized patients presenting with documented severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output to maintain systemic perfusion and preserve end-organ performance.	Short-term, continuous intravenous inotropic support may be reasonable	support	may
Heart Failure 2017 ACC/AHA/HFSA	32606	Long-term, continuous intravenous inotropic support may be considered as palliative therapy for symptom control in select patients with stage D Heart Failure despite optimal GDMT and device therapy who are not eligible for either MCS or cardiac transplantation.	Long-term, continuous intravenous inotropic support may be considered as palliative therapy for symptom control	support	may
Heart Failure 2017 ACC/AHA/HFSA	32607	Long-term use of either continuous or intermittent, intravenous parenteral positive inotropic agents, in the absence of specific indications or for reasons other than palliative care, is potentially harmful in the patient with Heart Failure.	Long-term use of either continuous or intermittent, intravenous parenteral positive inotropic agents is potentially harmful	use	potentially
Heart Failure 2017 ACC/AHA/HFSA	32608	Use of parenteral inotropic agents in hospitalized patients without documented severe systolic dysfunction, low blood pressure, or impaired perfusion, and evidence of significantly depressed cardiac output, with or without congestion, is potentially harmful.	Use of parenteral inotropic agents is potentially harmful
Heart Failure 2017 ACC/AHA/HFSA	32609	MCS is beneficial in carefully selected patients with stage D Heart FailurerEF in whom definitive management (eg, cardiac transplantation) or cardiac recovery is anticipated or planned.	MCS is beneficial	use
Heart Failure 2017 ACC/AHA/HFSA	32610	Nondurable MCS, including the use of percutaneous and extracorporeal ventricular assist devices, is reasonable as a “bridge to recovery” or a “bridge to decision” for carefully selecteda Heart FailurerEF a H patients with acute, profound hemodynamic compromise.	Nondurable MCS, including the use of percutaneous and extracorporeal ventricular assist devices, is reasonable as a “bridge to recovery” or a “bridge to decision”	use
Heart Failure 2017 ACC/AHA/HFSA	32611	Durable MCS is reasonable to prolong survival for carefully selecteda a patients with stage D Heart FailurerEF.	Durable MCS is reasonable
Heart Failure 2017 ACC/AHA/HFSA	32612	Evaluation for cardiac transplantation is indicated for carefully selected patients with stage D Heart Failure despite GDMT, device, and surgical management.	Evaluation for cardiac transplantation is indicated	evaluate
Heart Failure 2017 ACC/AHA/HFSA	32613	ACS precipitating acute Heart Failure decompensation should be promptly identified by ECG and serum biomarkers, including cardiac troponin testing, and treated optimally as appropriate to the overall condition and prognosis of the patient.	should be promptly identified by ECG and serum biomarkers, including cardiac troponin testing,	identify	should
Heart Failure 2017 ACC/AHA/HFSA	32613	ACS precipitating acute Heart Failure decompensation should be promptly identified by ECG and serum biomarkers, including cardiac troponin testing, and treated optimally as appropriate to the overall condition and prognosis of the patient.	and treated optimally as appropriate to the overall condition and prognosis of the patient.	treat	should
Heart Failure 2017 ACC/AHA/HFSA	32614	Common precipitating factors for acute Heart Failure should be considered during initial evaluation, as recognition of these conditions is critical to guide appropriate therapy.	common precipitating factors for acute HF should be considered
Heart Failure 2017 ACC/AHA/HFSA	32615	In patients with Heart FailurerEF experiencing a symptomatic exacerbation of Heart Failure requiring hospitalization during chronic maintenance treatment with GDMT, it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications.	it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications.	continue	recommended
Heart Failure 2017 ACC/AHA/HFSA	32616	Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients.	Initiation of beta-blocker therapy at a low dose is recommended
Heart Failure 2017 ACC/AHA/HFSA	32617	Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients.	Initiation of beta-blocker therapy at a low dose is recommended
Heart Failure 2017 ACC/AHA/HFSA	32616	Caution should be used when initiating the use of beta blockers in patients who have required inotropes during their hospital course.	Caution should be used when initiating the use of beta blockers
Heart Failure 2017 ACC/AHA/HFSA	32617	Caution should be used when initiating the use of beta blockers in patients who have required inotropes during their hospital course.	Caution should be used when initiating the use of beta blockers
Heart Failure 2017 ACC/AHA/HFSA	32618	Patients with Heart Failure admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to reduce morbidity.	should be promptly treated with intravenous loop diuretics
Heart Failure 2017 ACC/AHA/HFSA	32619	If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose	the initial intravenous dose should equal or exceed their chronic oral daily dose	give	should
Heart Failure 2017 ACC/AHA/HFSA	32619	If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose	should be given as either intermittent boluses or continuous infusion.	give	should
Heart Failure 2017 ACC/AHA/HFSA	32619	If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose	Urine output and signs and symptoms of congestion should be serially assessed,	assess	should
Heart Failure 2017 ACC/AHA/HFSA	32619	If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose	and the diuretic dose should be adjusted accordingly to relieve symptoms, reduce volume excess, and avoid hypotension.	adjust	should
Heart Failure 2017 ACC/AHA/HFSA	32620	The effect of Heart Failure treatment should be monitored with careful measurement of fluid intake and output, vital signs, body weight that is determined at the same time each day, and clinical signs and symptoms of systemic perfusion and congestion. Daily serum electrolytes, urea nitrogen, and creatinine concentrations should be measured during the use of intravenous diuretics or active titration of Heart Failure medications.	The effect of HF treatment should be monitored with careful measurement of fluid intake and output, vital signs, body weight that is determined at the same time each day, and clinical signs and symptoms of systemic perfusion and congestion	monitor	should
Heart Failure 2017 ACC/AHA/HFSA	32620	The effect of Heart Failure treatment should be monitored with careful measurement of fluid intake and output, vital signs, body weight that is determined at the same time each day, and clinical signs and symptoms of systemic perfusion and congestion. Daily serum electrolytes, urea nitrogen, and creatinine concentrations should be measured during the use of intravenous diuretics or active titration of Heart Failure medications.	Daily serum electrolytes, urea nitrogen, and creatinine concentrations should be measured during the use of intravenous diuretics or active titration of HF medications.	measure	should
Heart Failure 2017 ACC/AHA/HFSA	32621	When diuresis is inadequate to relieve symptoms, it is reasonable to intensify the diuretic regimen using either: a. Higher doses of intravenous loop diuretics (IIa-B), or b. Addition of a second (eg, thiazide) diuretic (IIa-B).	it is reasonable to intensify the diuretic regimen using higher doses of intravenous loop diuretics	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32621	When diuresis is inadequate to relieve symptoms, it is reasonable to intensify the diuretic regimen using either: a. Higher doses of intravenous loop diuretics (IIa-B), or b. Addition of a second (eg, thiazide) diuretic (IIa-B).	it is reasonable to intensify the diuretic regimen using addition of a second (eg, thiazide) diuretic
Heart Failure 2017 ACC/AHA/HFSA	32622	Low-dose dopamine infusion may be considered in addition to loop diuretic therapy to improve diuresis and better preserve renal functio and renal blood flow.	Low-dose dopamine infusion may be considered in addition to loop diuretic therapy		may
Heart Failure 2017 ACC/AHA/HFSA	32623	Ultrafiltration may be considered for patients with obvious volume overload to alleviate congestive symptoms and fluid weight.	Ultrafiltration may be considered to alleviate congestive symptoms and fluid weight
Heart Failure 2017 ACC/AHA/HFSA	32624	Ultrafiltration may be considered for patients with refractory congestion not responding to medical therapy.	Ultrafiltration may be considered	use	may
Heart Failure 2017 ACC/AHA/HFSA	32625	If symptomatic hypotension is absent, intravenous nitroglycerin, nitroprusside, or nesiritide may be considered as an adjuvant to diuretic therapy for relief of dyspnea in patients admitted with acute decompensated Heart Failure.	intravenous nitroglycerin, nitroprusside, or nesiritide may be considered as an adjuvant to diuretic therapy for relief of dyspnea
Heart Failure 2017 ACC/AHA/HFSA	32626	A patient admitted to the hospital with decompensated Heart Failure should receive venous thromboembolism prophylaxis with an anticoagulant medication if the risk–benefit ratio is favorable.	should receive venous thromboembolism prophylaxis with an anticoagulant medication
Heart Failure 2017 ACC/AHA/HFSA	32627	In patients hospitalized with volume overload, including Heart Failure, who have persistent severe hyponatremia and are at risk for or having active cognitive symptoms despite water restriction and maximization of GDMT, vasopressin antagonists may be considered in the short term to improve serum sodium concentration in hypervolemic, hyponatremic states with either a V2 receptor–selective or a nonselective vasopressin antagonist.	vasopressin antagonists may be considered in the short term to improve serum sodium concentration in hypervolemic, hyponatremic states with either a V2 receptor–selective or a nonselective vasopressin antagonist
Heart Failure 2017 ACC/AHA/HFSA	32628	The use of performance improvement systems and/or evidence-based systems of care is recommended in the hospital and early postdischarge outpatient setting to identify appropriate Heart Failure patients for GDMT, provide clinicians with useful reminders to advance GDMT, and assess the clinical response.	The use of performance improvement systems and/or evidence-based systems of care is recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32629	Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of Heart Failure, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of Heart Failure therapy, as appropriate d. Titration and optimization of chronic oral Heart Failure therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of Heart Failure education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients	Initiation of GDMT if not previously established and not contraindicated b.
Heart Failure 2017 ACC/AHA/HFSA	32629	Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of Heart Failure, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of Heart Failure therapy, as appropriate d. Titration and optimization of chronic oral Heart Failure therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of Heart Failure education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients	Precipitant causes of HF, barriers to optimal care transitions, and limitations in postdischarge support c.
Heart Failure 2017 ACC/AHA/HFSA	32629	Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of Heart Failure, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of Heart Failure therapy, as appropriate d. Titration and optimization of chronic oral Heart Failure therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of Heart Failure education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients	Assessment of volume status and supine/upright hypotension with adjustment of HF therapy, as appropriate
Heart Failure 2017 ACC/AHA/HFSA	32629	Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of Heart Failure, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of Heart Failure therapy, as appropriate d. Titration and optimization of chronic oral Heart Failure therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of Heart Failure education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients	Titration and optimization of chronic oral HF therapy
Heart Failure 2017 ACC/AHA/HFSA	32629	Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of Heart Failure, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of Heart Failure therapy, as appropriate d. Titration and optimization of chronic oral Heart Failure therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of Heart Failure education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients	Assessment of renal function and electrolytes, where appropriate
Heart Failure 2017 ACC/AHA/HFSA	32629	Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of Heart Failure, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of Heart Failure therapy, as appropriate d. Titration and optimization of chronic oral Heart Failure therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of Heart Failure education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients	Assessment and management of comorbid conditions
Heart Failure 2017 ACC/AHA/HFSA	32629	Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of Heart Failure, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of Heart Failure therapy, as appropriate d. Titration and optimization of chronic oral Heart Failure therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of Heart Failure education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients	Reinforcement of HF education, self-care, emergency plans, and need for adherence
Heart Failure 2017 ACC/AHA/HFSA	32629	Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of Heart Failure, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of Heart Failure therapy, as appropriate d. Titration and optimization of chronic oral Heart Failure therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of Heart Failure education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients	Consideration for palliative care or hospice care in selected patients
Heart Failure 2017 ACC/AHA/HFSA	32630	Multidisciplinary Heart Failure disease-management programs are recommended for patients at high risk for hospital readmission, to facilitate the implementation of GDMT, to address different barriers to behavioral change, and to reduce the risk of subsequent rehospitalization for Heart Failure.	Multidisciplinary HF disease-management programs are recommended	use	recommended
Heart Failure 2017 ACC/AHA/HFSA	32631	Scheduling an early follow-up visit (within 7–14 days) and early telephone follow-up (within 3 days) of hospital discharge is reasonable.	Scheduling an early follow-up visit (within 7–14 days) and early telephone follow-up	schedule	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32632	Use of clinical risk-prediction tools and/or biomarkers to identify patients at higher risk for postdischarge clinical events is reasonable.	Use of clinical risk-prediction tools and/or biomarkers	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32633	In patients with NYHA class II and III Heart Failure and iron deficiency (ferritin <100 ng/mL or 100–300 ng/mL if transferrin saturation is <20%), intravenous iron replacement might be reasonable to improve functional status and QoL.	intravenous iron replacement might be reasonable to improve functional status and QoL	use	might be reasonable
Heart Failure 2017 ACC/AHA/HFSA	32634	In patients with Heart Failure and anemia, erythropoietin-stimulating agents should not be used to improve morbidity and mortality.	erythropoietin-stimulating agents should not be used to improve morbidity and mortality
Heart Failure 2017 ACC/AHA/HFSA	32635	In patients at increased risk, stage A Heart Failure, the optimal blood pressure in those with hypertension should be <130/80 mm Hg.	the optimal blood pressure should be <130/80 mm Hg.	measure	should
Heart Failure 2017 ACC/AHA/HFSA	32636	Patients with Heart FailurerEF and hypertension should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg.	should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg.	prescribe	should
Heart Failure 2017 ACC/AHA/HFSA	32637	Patients with Heart FailurepEF and persistent hypertension after management of volume overload should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg	should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg	prescribe	should
Heart Failure 2017 ACC/AHA/HFSA	32638	In patients with NYHA class II–IV Heart Failure and suspicion of sleep disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable	a formal sleep assessment is reasonable	assess	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32639	In patients with cardiovascular disease and obstructive sleep apnea, CPAP may be reasonable to improve sleep quality and daytime sleepiness	continuous positive airway pressure may be reasonable	use	may be reasonable
Heart Failure 2017 ACC/AHA/HFSA	32640	In patients with NYHA class II–IV Heart FailurerEF and central sleep apnea, adaptive servo-ventilation causes harm	adaptive servo-ventilation causes harm	use
Heart Failure 2017 ACC/AHA/HFSA	32641	Coronary artery revascularization via coronary artery bypass graft (CABG) or percutaneous intervention is indicated for patients (Heart FailurepEF and Heart FailurerEF) on GDMT with angina and suitable coronary anatomy, especially for a left main stenosis (>50%) or left main–equivalent disease. (I-C)	Coronary artery revascularization via coronary artery bypass graft	perform	indicated
Heart Failure 2017 ACC/AHA/HFSA	32641	Coronary artery revascularization via coronary artery bypass graft (CABG) or percutaneous intervention is indicated for patients (Heart FailurepEF and Heart FailurerEF) on GDMT with angina and suitable coronary anatomy, especially for a left main stenosis (>50%) or left main–equivalent disease. (I-C)	or percutaneous intervention
Heart Failure 2017 ACC/AHA/HFSA	32642	Coronary artery revascularization via coronary artery bypass graft to improve survival is reasonable in patients with mild to moderate LV systolic dysfunction (EF 35%–50%) and significant (?70% diameter stenosis) multivessel CAD or proximal left anterior descending (LAD) coronary artery stenosis when viable myocardium is present in the region of intended revascularization. (IIa-B)	Coronary artery revascularization via coronary artery bypass graft to improve survival is reasonable	perform	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32643	CABG or medical therapy is reasonable to improve morbidity and cardiovascular mortality for patients with severe LV dysfunction (EF <35%), Heart Failure, and significant CAD.	coronary artery bypass graft	perform	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32643	CABG or medical therapy is reasonable to improve morbidity and cardiovascular mortality for patients with severe LV dysfunction (EF <35%), Heart Failure, and significant CAD.	medical therapy	use	reasonable
Heart Failure 2017 ACC/AHA/HFSA	32644	Surgical aortic valve replacement is reasonable for patients with critical aortic stenosis and a predicted surgical mortality of <10%. (IIa-B)	Surgical aortic valve replacement is reasonable
Heart Failure 2017 ACC/AHA/HFSA	32645	Transcatheter aortic valve replacement after careful candidate consideration is reasonable for patients with critical aortic stenosis who are deemed inoperable. (IIa-B)	Transcatheter aortic valve replacement after careful candidate consideration is reasonable
Heart Failure 2017 ACC/AHA/HFSA	32646	CABG may be considered with the intent of improving survival in patients with ischemic heart disease with severe LV systolic dysfunction (EF <35%) and operable coronary anatomy whether or not viable myocardium is present. (IIb-B)	coronary artery bypass graft may be considered		may
Heart Failure 2017 ACC/AHA/HFSA	32647	Transcatheter mitral valve repair or mitral valve surgery for functional mitral insufficiency is of uncertain benefit and should only be considered after careful candidate selection and with a background of GDMT.	Transcatheter mitral valve repair or mitral valve surgery for functional mitral insufficiency is of uncertain benefit and should only be considered
Heart Failure 2017 ACC/AHA/HFSA	32648	Surgical reverse remodeling or LV aneurysmectomy may be considered in carefully selected patients with Heart FailurerEF for specific indications including intractable Heart Failure and ventricular arrhythmias.	Surgical reverse remodeling		may
Heart Failure 2017 ACC/AHA/HFSA	32648	Surgical reverse remodeling or LV aneurysmectomy may be considered in carefully selected patients with Heart FailurerEF for specific indications including intractable Heart Failure and ventricular arrhythmias.	or LV aneurysmectomy may be considered		may
Heart Failure 2017 ACC/AHA/HFSA	32649	Effective systems of care coordination with special attention to care transitions should be deployed for every patient with chronic Heart Failure that facilitate and ensure effective care that is designed to achieve GDMT and prevent hospitalization.	Effective systems of care coordination with special attention to care transitions should be deployed	deploy	should
Heart Failure 2017 ACC/AHA/HFSA	32650	Every patient with Heart Failure should have a clear, detailed, and evidencebased plan of care that ensures the achievement of GDMT goals, effective management of comorbid conditions, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient’s healthcare team. (I-C)	should have a clear, detailed, and evidencebased plan of care
Heart Failure 2017 ACC/AHA/HFSA	32650	Every patient with Heart Failure should have a clear, detailed, and evidencebased plan of care that ensures the achievement of GDMT goals, effective management of comorbid conditions, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient’s healthcare team. (I-C)	should be updated regularly a
Heart Failure 2017 ACC/AHA/HFSA	32650	Every patient with Heart Failure should have a clear, detailed, and evidencebased plan of care that ensures the achievement of GDMT goals, effective management of comorbid conditions, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient’s healthcare team. (I-C)	made readily available to all members of each patient’s healthcare team
Heart Failure 2017 ACC/AHA/HFSA	32651	Palliative and supportive care is effective for patients with symptomatic advanced Heart Failure to improve quality of life. (I-B)	Palliative and supportive care is effective
Heart Failure 2017 ACC/AHA/HFSA	32652	Performance measures based on professionally developed clinical practice guidelines should be used with the goal of improving quality of care for Heart Failure.	Performance measures based on professionally developed clinical practice guidelines should be used with the goal of improving quality of care .	use	should
Heart Failure 2017 ACC/AHA/HFSA	32653	Participation in quality improvement programs and patient registries based on nationally endorsed, clinical practice guideline–based quality and performance measures can be beneficial in improving quality of Heart Failure care.	Participation in quality improvement programs and patient registries based on nationally endorsed, clinical practice guideline–based quality and performance measures can be beneficial
Hospital-Acquired and VentilatorAssociated Pneumonia	32654	We suggest noninvasive sampling with semiquantitative cultures to diagnose VAP, rather than invasive sampling with quantitative cultures and rather than noninvasive sampling with quantitative cultures	perform noninvasive sampling with semiquantitative cultures	perform	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32654	We suggest noninvasive sampling with semiquantitative cultures to diagnose VAP, rather than invasive sampling with quantitative cultures and rather than noninvasive sampling with quantitative cultures	invasive sampling with quantitative cultures	perform	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32654	We suggest noninvasive sampling with semiquantitative cultures to diagnose VAP, rather than invasive sampling with quantitative cultures and rather than noninvasive sampling with quantitative cultures	noninvasive sampling with quantitative cultures	perform	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32655	Noninvasive sampling with semiquantitative cultures is the preferred methodology to diagnose VAP (see section I); however, the panel recognizes that invasive quantitative cultures will occasionally be performed by some clinicians. For patients with suspected VAP whose invasive quantitative culture results are below the diagnostic threshold for VAP, we suggest that antibiotics be withheld rather than continued	withhold antibiotics rather than continuing	withhold	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32656	We suggest that patients with suspected HAP (non-VAP) be treated according to the results of microbiologic studies performed on respiratory samples obtained noninvasively, rather than being treated empirically	treat according to the results of microbiologic studies performed on respiratory samples obtained noninvasively
Hospital-Acquired and VentilatorAssociated Pneumonia	32656	We suggest that patients with suspected HAP (non-VAP) be treated according to the results of microbiologic studies performed on respiratory samples obtained noninvasively, rather than being treated empirically	treat with empiric antibiotic therapy
Hospital-Acquired and VentilatorAssociated Pneumonia	32657	For patients with suspected HAP/VAP, we recommend using clinical criteria alone, rather than using serum PCT plus clinical criteria, to decide whether or not to initiate antibiotic therapy	use clinical criteria alone to decide whether or not to initiate antibiotic therapy	use	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32657	For patients with suspected HAP/VAP, we recommend using clinical criteria alone, rather than using serum PCT plus clinical criteria, to decide whether or not to initiate antibiotic therapy	use serum PCT plus clinical criteria	use	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32658	For patients with suspected HAP/VAP, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (BALF) sTREM-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy	using clinical criteria alone to decide whether or not to initiate antibiotic therapy	use	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32658	For patients with suspected HAP/VAP, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (BALF) sTREM-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy	using bronchoalveolar lavage fluid (BALF) sTREM-1 plus clinical criteria	use
Hospital-Acquired and VentilatorAssociated Pneumonia	32659	For patients with suspected HAP/VAP, we recommend using clinical criteria alone rather than using CRP plus clinical criteria, to decide whether or not to initiate antibiotic therapy	use clinical criteria alone to decide whether or not to initiate antibiotic therapy	use	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32659	For patients with suspected HAP/VAP, we recommend using clinical criteria alone rather than using CRP plus clinical criteria, to decide whether or not to initiate antibiotic therapy	use CRP plus clinical criteria	use	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32660	For patients with suspected HAP/VAP, we suggest using clinical criteria alone, rather than using CPIS plus clinical criteria, to decide whether or not to initiate antibiotic therapy	use clinical criteria alone to decide whether or not to initiate antibiotic therapy	use	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32660	For patients with suspected HAP/VAP, we suggest using clinical criteria alone, rather than using CPIS plus clinical criteria, to decide whether or not to initiate antibiotic therapy	use CPIS plus clinical criteria	use	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32661	In patients with VAT, we suggest not providing antibiotic therapy	do not provide antibiotic therapy	provide	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32662	In patients with suspected VAP, we recommend including coverage for S. aureus, Pseudomonas aeruginosa, and other gram-negative bacilli in all empiric regimens	including coverage for S. aureus, Pseudomonas aeruginosa, and other gram-negative bacilli in all empiric regimens	including	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32663	We suggest including an agent active against MRSA for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 2), patients being treated in units where >10%–20% of S. aureus isolates are methicillin resistant, and patients in units where the prevalence of MRSA is not known	including an agent active against MRSA for the empiric treatment of suspected VAP	include	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32664	We suggest including an agent active against methicillinsensitive S. aureus (MSSA) (and not MRSA) for the empiric treatment of suspected VAP in patients without risk factors for antimicrobial resistance, who are being treated in ICUs where <10%–20% of S. aureus isolates are methicillin resistant (weak recommendation, very low-quality evidence).	including an agent active against methicillinsensitive S. aureus (MSSA) (and not MRSA) for the empiric treatment of suspected VAP		suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32665	If empiric coverage for MRSA is indicated, we recommend either vancomycin or linezolid	treat with vancomycin	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32665	If empiric coverage for MRSA is indicated, we recommend either vancomycin or linezolid	treat with linezolid	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32666	When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA, but are not necessary for the empiric treatment of VAP if one of the above agents is used.	a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem	treat	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32667	When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA, but are not necessary for the empiric treatment of VAP if one of the above agents is used.	a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem	treat	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32666	Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA, but are not necessary for the empiric treatment of VAP if one of the above agents is used	Oxacillin, nafcillin, or cefazolin are preferred agents but are not necessary for the empiric treatment of VAP if one of the above agents is used
Hospital-Acquired and VentilatorAssociated Pneumonia	32667	Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA, but are not necessary for the empiric treatment of VAP if one of the above agents is used	Oxacillin, nafcillin, or cefazolin are preferred agents but are not necessary for the empiric treatment of VAP if one of the above agents is used
Hospital-Acquired and VentilatorAssociated Pneumonia	32668	We suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an ICU where local antimicrobial susceptibility rates are not available	prescribe 2 antipseudomonal antibiotics from different classes	prescibe	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32669	We suggest prescribing one antibiotic active against P. aeruginosa for the empiric treatment of suspected VAP in patients without risk factors for antimicrobial resistance who are being treated in ICUs where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy	prescribing one antibiotic active against P. aeruginosa	prescribe	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32670	In patients with suspected VAP, we suggest avoiding aminoglycosides if alternative agents with adequate gram-negative activity are available	avoid aminoglycosides	avoid	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32671	In patients with suspected VAP, we suggest avoiding colistin if alternative agents with adequate gram-negative activity are available	avoiding colistin	avoid	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32672	For patients being treated empirically for HAP, we recommend prescribing an antibiotic with activity against S. aureus	prescribing an antibiotic with activity against S. aureus	prescribing	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32673	For patients with HAP who are being treated empirically and have either a risk factor for MRSA infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where >20% of S. aureus isolates are methicillin resistant, or the prevalence of MRSA is not known, or who are at high risk for mortality, we suggest prescribing an antibiotic with activity against MRSA	prescribing an antibiotic with activity against MRSA	prescribe	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32674	For patients with HAP who require empiric coverage for MRSA, we recommend vancomycin or linezolid rather than an alternative antibiotic	treat with vancomycin or linezolid rather than an alternative antibiotic	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32675	For patients with HAP who are being treated empirically and have no risk factors for MRSA infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against MSSA. When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA, but are not necessary for empiric coverage of HAP if one of the above agents is used	prescribing an antibiotic with activity against MSSA.
Hospital-Acquired and VentilatorAssociated Pneumonia	32676	For patients with HAP who are being treated empirically and have no risk factors for MRSA infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against MSSA. When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA, but are not necessary for empiric coverage of HAP if one of the above agents is used	prescribing an antibiotic with activity against MSSA.
Hospital-Acquired and VentilatorAssociated Pneumonia	32675	When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA, but are not necessary for empiric coverage of HAP if one of the above agents is used	a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem.
Hospital-Acquired and VentilatorAssociated Pneumonia	32676	When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA, but are not necessary for empiric coverage of HAP if one of the above agents is used	a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem.
Hospital-Acquired and VentilatorAssociated Pneumonia	32677	For patients with HAP who are being treated empirically, we recommend prescribing antibiotics with activity against P. aeruginosa and other gram-negative bacilli	prescribing antibiotics with activity against P. aeruginosa and other gram-negative bacilli	prescribe	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32678	For patients with HAP who are being treated empirically and have factors increasing the likelihood for Pseudomonas or other gram-negative infection (ie, prior intravenous antibiotic use within 90 days; also see Remarks) or a high risk for mortality, we suggest prescribing antibiotics from 2 different classes with activity against P. aeruginosa	prescribing antibiotics from 2 different classes with activity against P. aeruginosa
Hospital-Acquired and VentilatorAssociated Pneumonia	32679	For patients with HAP who are being treated empirically, we recommend not using an aminoglycoside as the sole antipseudomonal agent	not using an aminoglycoside as the sole antipseudomonal agent	not use	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32680	For patients with HAP/VAP, we suggest that antibiotic dosing be determined using PK/PD data, rather than the manufacturer’s prescribing information	antibiotic dosing be determined using PK/PD data, rather than the manufacturer’s prescribing information	determine	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32681	For patients with VAP due to gram-negative bacilli that are susceptible to only aminoglycosides or polymyxins (colistin or polymyxin B), we suggest both inhaled and systemic antibiotics, rather than systemic antibiotics alone	use both inhaled and systemic antibiotics, rather than systemic antibiotics alone	use	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32682	We recommend that MRSA HAP/VAP be treated with either vancomycin or linezolid rather than other antibiotics or antibiotic combinations	treated with either vancomycin or linezolid rather than other antibiotics or antibiotic combinations	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32683	For patients with HAP/VAP due to P. aeruginosa, we recommend that the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing	choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing	choose	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32684	For patients with HAP/VAP due to P. aeruginosa, we recommend against aminoglycoside monotherapy (strong recommendation, very low-quality evidence).	against treating with aminoglycoside monotherapy	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32685	For patients with HAP/VAP due to P. aeruginosa who are not in septic shock or at a high risk for death, and for whom the results of antibiotic susceptibility testing are known, we recommend monotherapy using an antibiotic to which the isolate is susceptible rather than combination therapy	treat with monotherapy using an antibiotic to which the isolate is susceptible rather than combination therapy	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32686	For patients with HAP/VAP due to P. aeruginosa who remain in septic shock or at a high risk for death when the results of antibiotic susceptibility testing are known, we suggest combination therapy using 2 antibiotics to which the isolate is susceptible rather than monotherapy	treat with combination therapy using 2 antibiotics to which the isolate is susceptible rather than monotherapy	treat	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32687	For patients with HAP/VAP due to P. aeruginosa, we recommend against aminoglycoside monotherapy	against treating with aminoglycoside monotherapy
Hospital-Acquired and VentilatorAssociated Pneumonia	32688	For patients with HAP/VAP due to ESBL-producing gramnegative bacilli, we recommend that the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing and patient-specific factors	the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing and patient-specific factors	choose	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32689	In patients with HAP/VAP caused by Acinetobacter species, we suggest treatment with either a carbapenem or ampicillin/sulbactam if the isolate is susceptible to these agents	treatment with either a carbapenem or ampicillin/sulbactam	treat	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32690	In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we recommend intravenous polymyxin (colistin or polymyxin B)	treat with intravenous polymyxin (colistin or polymyxin B)	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32691	In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin	treat with adjunctive inhaled colistin	treat	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32692	In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin	do not treat with adjunctive rifampicin	treat	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32693	In patients with HAP/VAP caused by Acinetobacter species, we recommend against the use of tigecycline	against the use of tigecycline	use	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32694	In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we recommend intravenous polymyxins (colistin or polymyxin B)	treat with intravenous polymyxins (colistin or polymyxin B)	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32695	In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin	treat with adjunctive inhaled colistin	treat	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32696	For patients with VAP, we recommend a 7-day course of antimicrobial therapy rather than a longer duration	treat with a 7-day course of antimicrobial therapy rather than a longer duration	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32697	For patients with HAP, we recommend a 7-day course of antimicrobial therapy	treat with a 7-day course of antimicrobial therapy	treat	recommend
Hospital-Acquired and VentilatorAssociated Pneumonia	32698	For patients with HAP/VAP, we suggest that antibiotic therapy be de-escalated rather than fixed	antibiotic therapy be de-escalated rather than fixed	de-escalate	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32699	For patients with HAP/VAP, we suggest using PCT levels plus clinical criteria to guide the discontinuation of antibiotic therapy, rather than clinical criteria alone	using PCT levels plus clinical criteria to guide the discontinuation of antibiotic therapy, rather than clinical criteria alone	use	suggest
Hospital-Acquired and VentilatorAssociated Pneumonia	32700	For patients with suspected HAP/VAP, we suggest not using the CPIS to guide the discontinuation of antibiotic therapy	not using the CPIS to guide the discontinuation of antibiotic therapy	use	suggest
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32701	Gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma are recommended to help identify whether Staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause	use gram stain and culture of the pus or exudates from skin lesions to identify whether Staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32702	Treatment without gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma is reasonable in typical cases	it is reasonable in typical cases to treat without identifying whether Staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause	Treat	reasonable
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32703	Treatment of bullous and nonbullous impetigo should be with either mupirocin or retapamulin bid for 5 days	treatment with either mupirocin or retapamulin twice daily for 5 days	treat	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32704	Oral therapy for ecthyma or impetigo should be a 7-day regimen with an agent active against S. aureus unless cultures yield streptococci alone (when oral penicillin is the recommended agent)	Oral therapy should be a 7-day regimen with an agent active against S. aureus	treat	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32704	Oral therapy for ecthyma or impetigo should be a 7-day regimen with an agent active against S. aureus unless cultures yield streptococci alone (when oral penicillin is the recommended agent)	unless cultures yield streptococci alone (when oral penicillin is the recommended agent)	treat	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32705	Because Staphylococcus aureus isolates from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or cephalexin is recommended.	use dicloxacillin	use
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32706	Because Staphylococcus aureus isolates from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or cephalexin is recommended.	use dicloxacillin	use
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32705	Because Staphylococcus aureus isolates from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or cephalexin is recommended.	use cephalexin	use
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32706	Because Staphylococcus aureus isolates from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or cephalexin is recommended.	use cephalexin	use
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32705	When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended	use doxycycline	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32706	When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended	use doxycycline	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32705	When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended	use clindamycin	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32706	When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended	use clindamycin	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32705	When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended	use sulfamethoxazole-trimethoprim	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32706	When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended	use sulfamethoxazole-trimethoprim	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32707	Systemic antimicrobials should be used for infections during outbreaks of post-streptococcal glomerulonephritis to help eliminate nephritogenic strains of Streptococcus pyogenes from the community	systemic antimicrobials should be used for infections to help eliminate nephritogenic strains of Streptococcus pyogenes from the community	use	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32708	Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases	use gram stain and culture of pus	treat	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32708	Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases	treatment without these studies is reasonable in typical cases	treat	reasonable
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32709	Gram stain and culture of pus from inflamed epidermoid cysts are NOT recommended	Gram stain and culture of pus are NOT recommended	treat	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32710	Incision and drainage is the recommended treatment for inflamed epidermoid cysts, carbuncles, abscesses and large furuncles	treat by incision and drainage	treat	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32711	The decision to administer antibiotics directed against S. aureus as an adjunct to incision and drainage should be made based on the presence or absence of systemic inflammatory response syndrome (SIRS) such as temperature >38°C or <36°C, tachypnea >24 breaths/min, tachycardia >90 beats/min or white blood cell count (WBC) >12,000 or <4000 cells/mm3	administer antibiotics directed against S. aureus as an adjunct to incision and drainage	administer	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32712	An antibiotic active against MRSA is recommended for patients with carbuncles or abscesses who have failed initial antibiotic treatment, have markedly impaired host defenses, or in patients with SIRS and hypotension	use an antibiotic active against MRSA (	use	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32713	A recurrent abscess at a site of previous infection should prompt a search for local causes such as a pilonidal cyst, hidradenitis suppurativa or foreign material	search for local causes such as a pilonidal cyst, hidradenitis suppurativa or foreign material	search	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32714	Recurrent abscesses should be drained and cultured early in the course of infection	recurrent abscesses should be drained and cultured	drain	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32715	After obtaining cultures of recurrent abscess, treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated	treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated	treat
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32716	Consider a 5-day decolonization regimen of intranasal mupirocin bid, daily chlorhexidine washes, and daily decontamination of personal items such as towels, sheets, and clothes for recurrent S. aureus infection (	Consider a 5-day decolonization regimen of intranasal mupirocin bid, daily chlorhexidine washes, and daily decontamination of personal items such as towels, sheets, and clothes	consider
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32717	Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood	adult patients should be evaluated for neutrophil disorders	evaluate	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32718	Cultures of blood or cutaneous aspirates, biopsies, or swabs are NOT routinely recommended	do not obtain cultures of blood	do not obtain
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32718	Cultures of blood or cutaneous aspirates, biopsies, or swabs are NOT routinely recommended	do not obtain cutaneous aspirates	do not obtain
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32718	Cultures of blood or cutaneous aspirates, biopsies, or swabs are NOT routinely recommended	do not obtain biopsies	do not obtain
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32718	Cultures of blood or cutaneous aspirates, biopsies, or swabs are NOT routinely recommended	do not obtain swabs	do not obtain
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32719	Cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites	obtain cultures of blood	obtain	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32720	cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites (	obtain cultures of blood	obtain	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32720	cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites (	obtain microscopic examination of cutaneous aspirates	obtain	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32720	cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites (	obtain biopsies	obtain	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32720	cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites (	obtain swabs	obtain	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32721	Typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci	should receive an antimicrobial agent that is active against streptococci	receive	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32722	For cellulitis with systemic signs of infection (See Fig. 1/Nonpurulent/MODERATE) systemic antibiotics are indicated. Many clinicians could include coverage against methicillin-susceptible S. aureus (MSSA) (	systemic antibiotics are indicated	prescribe	indicated
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32723	For patients whose cellulitis is associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or SIRS vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended	vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended	prescribe	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32724	In severely compromised patients (patients who have failed oral antibiotic treatment or those with systemic signs of infection (such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/?L), or those who are immunocompromised,or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction) broad-spectrum antimicrobial coverage may be considered	broad-spectrum antimicrobial coverage may be considered	consider	may
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32725	Vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as a reasonable empiric regimen for severe infections	Vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as a reasonable empiric regimen	prescribe	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32726	The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period	treatment should be extended	extend	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32727	Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended	Elevation of the affected area	elevate
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32727	Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended	treat predisposing factors, such as edema or underlying cutaneous disorders	treat	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32728	In lower extremity cellulitis, clinicians should carefully examine the interdigital toe spaces because treating fissuring, scaling, or maceration may eradicate colonization with pathogens and reduce the incidence of recurrent infection	carefully examine the interdigital toe spaces because treating fissuring, scaling, or maceration may eradicate colonization with pathogens and reduce the incidence of recurrent infection	examine	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32729	Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability	Outpatient therapy is recommended	perform	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32730	Hospitalization is recommended if there is concern for a deeper or necrotizing infection, for patients with poor adherence to therapy, for infection in a severely immunocompromised patient or if outpatient treatment is failing	hospitalization is recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32731	Systemic corticosteroids (eg, prednisone 40 mg daily for 7 days) could be considered in nondiabetic adult patients with cellulitis	Systemic corticosteroids (eg, prednisone 40 mg daily for 7 days) could be considered	prescribe	consider
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32732	Identify and treat predisposing conditions such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities. These practices should be performed as part of routine patient care and certainly during the acute stage of cellulitis.	Identify and treat predisposing conditions such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities.	Identify	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32733	Administration of prophylactic antibiotics, such as oral penicillin or erythromycin bid for 4-52 weeks, or intramuscular benzathine penicillin every 2-4 weeks should be considered in patients who have 3-4 episodes of cellulitis per year despite attempts to treat or control predisposing factors	administer prophylactic antibiotics, such as oral penicillin or erythromycin bid for 4-52 weeks	administer	should be considered
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32733	Administration of prophylactic antibiotics, such as oral penicillin or erythromycin bid for 4-52 weeks, or intramuscular benzathine penicillin every 2-4 weeks should be considered in patients who have 3-4 episodes of cellulitis per year despite attempts to treat or control predisposing factors	intramuscular benzathine penicillin every 2-4 weeks
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32734	This program should be continued so long as the predisposing factors persist	administration of prophylactic antibiotics, such as oral penicillin or erythromycin bid for 4-52 weeks, or intramuscular benzathine penicillin every 2-4 weeks should be continued
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32735	Suture removal plus incision and drainage should be performed for surgical site infections	Suture removal plus incision and drainage should be performed	perform	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32736	Adjunctive systemic antimicrobial therapy is NOT routinely indicated but in conjunction with incision and drainage may be beneficial for surgical site infections associated with a significant systemic response such as erythema and induration extending >5 cm from the wound edge, temperature >38.5ºC, heart rate >110/min, or WBC count >12,000/mm3	Adjunctive systemic antimicrobial therapy is NOT routinely indicated but in conjunction with incision and drainage may be beneficial
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32737	A brief course of systemic antimicrobial therapy is indicated in patients with surgical site infections after clean operations on the trunk, head and neck, or extremities that also have systemic signs of infection	a brief course of systemic antimicrobial therapy is indicated	perform	indicated
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32738	A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended	use a first-generation cephalosporin		recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32738	A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended	use an anti-staphylococcal penicillin for MSSA
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32738	A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended	use vancomycin
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32738	A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended	use linezolid
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32738	A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended	use daptomycin
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32738	A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended	use telavancin
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32738	A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended	use ceftaroline
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32739	Agents active against Gram-negative bacteria and anaerobes, such as a cephalosporin or fluoroquinolone in combination with metronidazole, are recommended for infections after operations on the axilla, gastrointestinal (GI) tract, perineum or female genital tract	Agents active against Gram-negative bacteria and anaerobes, such as a cephalosporin or fluoroquinolone in combination with metronidazole	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32740	Prompt surgical consultation is recommended for patients with aggressive infections associated with signs of systemic toxicity or suspicion of necrotizing fasciitis or gas gangrene	prompt surgical consultation	consult	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32741	Empiric antibiotic treatment should be broad (eg, vancomycin or linezolid plus piperacillin-tazobactam or plus a carbapenem; or plus ceftriaxone and metronidazole), since the etiology can be polymicrobial (mixed aerobic-anaerobic microbes) or monomicrobial (Group A streptococcus, community-acquired MRSA)	empiric antibiotic treatment should be broad (eg, vancomycin or linezolid plus piperacillin-tazobactam or plus a carbapenem; or plus ceftriaxone and metronidazole), since the etiology can be polymicrobial (mixed aerobic-anaerobic microbes) or monomicrobial (Group A streptococcus, community-acquired MRSA)	treat	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32742	Penicillin plus clindamycin is recommended for treatment of documented Group A streptococcal necrotizing fasciitis	use penicillin plus clindamycin	treat	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32743	Magnetic resonance imaging (MRI) is the recommended imaging modality for establishing the diagnosis of pyomyositis. Computed tomography (CT) scan and ultrasound studies are also useful.	use magnetic resonance imaging	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32743	Magnetic resonance imaging (MRI) is the recommended imaging modality for establishing the diagnosis of pyomyositis. Computed tomography (CT) scan and ultrasound studies are also useful.	computed tomography scan
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32743	Magnetic resonance imaging (MRI) is the recommended imaging modality for establishing the diagnosis of pyomyositis. Computed tomography (CT) scan and ultrasound studies are also useful.	ultrasound studies
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32744	Cultures of blood and abscess material should be obtained	obtain cultures of blood and abscess material	obtain	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32745	Vancomycin is recommended for initial empiric therapy. An agent active against enteric Gram-negative bacilli should be added for infection in immunocompromised patients or after open trauma to the muscles (SR-M).	Vancomycin is recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32745	Vancomycin is recommended for initial empiric therapy. An agent active against enteric Gram-negative bacilli should be added for infection in immunocompromised patients or after open trauma to the muscles (SR-M).	An agent active against enteric Gram-negative bacilli should be added for infection in immunocompromised patients or after open trauma to the muscles
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32746	Cefazolin or antistaphylococcal penicillin (eg, nafcillin or oxacillin) is recommended for treatment of pyomyositis caused by MSSA (SR-M).	Cefazolin
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32746	Cefazolin or antistaphylococcal penicillin (eg, nafcillin or oxacillin) is recommended for treatment of pyomyositis caused by MSSA (SR-M).	antistaphylococcal penicillin (eg, nafcillin or oxacillin)
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32747	Early drainage of purulent material should be performed	early drainage of purulent material should be performed
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32748	Repeat imaging studies should be performed in patients with persistent bacteremia to identify undrained foci of infection	perform repeat imaging studies
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32749	Antibiotics should be administered intravenously initially, but once the patient is clinically improved oral antibiotics are appropriate for patients in whom bacteremia cleared promptly and there is no evidence of endocarditis or metastatic abscess. Two to three weeks of therapy is recommended.	Initially administer antibiotics intravenously
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32749	Antibiotics should be administered intravenously initially, but once the patient is clinically improved oral antibiotics are appropriate for patients in whom bacteremia cleared promptly and there is no evidence of endocarditis or metastatic abscess. Two to three weeks of therapy is recommended.	Treat with oral antibiotics or metastatic abscess
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32750	Urgent surgical exploration of the suspected gas gangrene site and surgical debridement of involved tissue should be performed	perform urgent surgical exploration of the suspected gas gangrene site	perform	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32750	Urgent surgical exploration of the suspected gas gangrene site and surgical debridement of involved tissue should be performed	perform surgical debridement of involved tissue	perform	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32751	In the absence of a definitive etiologic diagnosis, broad-spectrum treatment with vancomycin plus either piperacillin/tazobactam, ampicillin/sulbactam or a carbapenem antimicrobial is recommended (SR-L).	broad-spectrum treatment with vancomycin plus either piperacillin/tazobactam, ampicillin/sulbactam or a carbapenem antimicrobial	treat	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32752	Definitive antimicrobial therapy with penicillin and clindamycin is recommended for treatment of clostridial myonecrosis (SR-L).	Definitive antimicrobial therapy with penicillin and clindamycin	perform	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32753	Hyperbaric oxygen therapy is NOT recommended because it has not been proven as a benefit to patients and may delay resuscitation and surgical debridement (SR-L).	do not use hyperbaric oxygen therapy because it has not been proven as a benefit to patients and may delay resuscitation and surgical debridement	do not use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32754	Preemptive early antimicrobial therapy for 3-5 days is recommended for patients who: a) are immunocompromised; b) are asplenic; c) have advanced liver disease; d) have preexisting or resultant edema of the affected area; e) have moderate to severe injuries, especially to the hand or face; or f) have injuries that may have penetrated the periosteum or joint capsule (SR-L).	Preemptive early antimicrobial therapy for 3-5 days	perform	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32755	Postexposure prophylaxis for rabies may be indicated. Consultation with local health officials is recommended to determine if vaccination should be initiated (SR-L).	may indicate postexposure prophylaxis for rabies	indicate	may
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32755	Postexposure prophylaxis for rabies may be indicated. Consultation with local health officials is recommended to determine if vaccination should be initiated (SR-L).	consult with local health officials to determine if vaccination should be initiated	consult	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32756	An antimicrobial agent or agents active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate should be used	use an antimicrobial agent or agents active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate	use	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32757	Tetanus toxoid should be administered to patients without toxoid vaccination within 10 years. Tdap is preferred over Td if the former has not been previously given (SR-L).	Tetanus toxoid should be administered. Tdap is preferred over Td if the former has not been previously given
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32758	Primary wound closure is NOT recommended for wounds, with the exception of those to the face, which should be managed with copious irrigation, cautious debridement and preemptive antibiotics.	use copious irrigation	use	recommended
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32758	Primary wound closure is NOT recommended for wounds, with the exception of those to the face, which should be managed with copious irrigation, cautious debridement and preemptive antibiotics.	primary wound closure	perform	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32758	Primary wound closure is NOT recommended for wounds, with the exception of those to the face, which should be managed with copious irrigation, cautious debridement and preemptive antibiotics.	cautious debridement	perform	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32758	Primary wound closure is NOT recommended for wounds, with the exception of those to the face, which should be managed with copious irrigation, cautious debridement and preemptive antibiotics.	preemptive antibiotics	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32759	Other wounds may be approximated (WR-L).	approximate	approximate	may
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32760	Oral penicillin V 500 mg qid for 7-10 days is the recommended treatment for naturally acquired cutaneous anthrax (SR-H).	treat with oral penicillin V 500 mg qid for 7-10 days
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32761	Ciprofloxacin 500 mg PO bid or levofloxacin 500 mg IV/PO q24h for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure.	treat with Ciprofloxacin 500 mg PO bid o	treat	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32761	Ciprofloxacin 500 mg PO bid or levofloxacin 500 mg IV/PO q24h for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure.	treat with levofloxacin 500 mg IV/PO q24h for 60 days	treat	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32762	Azithromycin is recommended for cat scratch disease. Patients >45 kg, 500 mg on day 1 followed by 250 mg for 4 additional days. Patients <45 kg, 10 mg/kg on day 1 and 5 mg/kg for 4 more days	treat with Azithromycin Patients >45 kg, 500 mg on day 1 followed by 250 mg for 4 additional days.	treat	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32762	Azithromycin is recommended for cat scratch disease. Patients >45 kg, 500 mg on day 1 followed by 250 mg for 4 additional days. Patients <45 kg, 10 mg/kg on day 1 and 5 mg/kg for 4 more days	treat with Azithromycin. Patients <45 kg, 10 mg/kg on day 1 and 5 mg/kg for 4 more days
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32763	Erythromycin 500 mg qid or doxycycline 100 mg bid for 2 weeks to 2 months is recommended for treatment of bacillary angiomatosis (SR-M).	treat with Erythromycin 500 mg qid or doxycycline 100 mg bid for 2 weeks to 2 months
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32764	Penicillin 500 mg qid or amoxicillin 500 mg tid for 7-10 days is recommended for treatment of erysipeloid (SR-H).	treat with Penicillin 500 mg qid or amoxicillin 500 mg tid for 7-10 days
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32765	Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L).	treat with Ceftazidime
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32765	Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L).	treat with gentamicin
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32765	Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L).	treat with imipenem
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32765	Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L).	treat with doxycycline
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32765	Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L).	treat with ciprofloxacin
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32766	Bubonic plague should be diagnosed by Gram stain and culture of aspirated material from a suppurative lymph node	perform Gram stain and culture of aspirated material from a suppurative lymph node	perform	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32767	Streptomycin 15 mg/kg IM q12h or doxycycline 100 mg bid PO is recommended for treatment of bubonic plague (SR-L).	treat with Streptomycin 15 mg/kg IM q12h or doxycycline 100 mg bid PO
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32768	Gentamicin could be substituted for streptomycin	Gentamicin could be substituted for streptomycin	substitute	could
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32769	Serologic tests are the preferred method of diagnosing tularemia (WR-L).	use serologic tests	use	preferred
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32770	Streptomycin 15 mg/kg q12h IM or gentamicin 1.5 mg/kg q8h IV is recommended for treatment of severe cases of tularemia (SR-L).	use Streptomycin 15 mg/kg q12h IM or gentamicin 1.5 mg/kg q8h IV	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32771	Tetracycline 500 mg qid or doxycycline 100 mg bid PO is recommended for treatment of mild cases of tularemia (SR-L).	use tetracycline 500 mg qid or doxycycline 100 mg bid PO is	use	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32772	Notify the microbiology laboratory if tularemia is suspected (SR-H).	Notify the microbiology laboratory	notify
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32773	In addition to infection, differential diagnosis of skin lesions should include drug eruption, cutaneous infiltration with the underlying malignancy, chemotherapy- or radiation-induced reactions, Sweet’s syndrome, erythema multiforme, leukocytoclastic vasculitis and graftversus-host disease among allogeneic transplant recipients (SR-H).	differential diagnosis of skin lesions should include drug eruption, cutaneous infiltration with the underlying malignancy, chemotherapy- or radiation-induced reactions, Sweet’s syndrome, erythema multiforme, leukocytoclastic vasculitis and graftversus-host disease among allogeneic transplant recipients.
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32773	In addition to infection, differential diagnosis of skin lesions should include drug eruption, cutaneous infiltration with the underlying malignancy, chemotherapy- or radiation-induced reactions, Sweet’s syndrome, erythema multiforme, leukocytoclastic vasculitis and graftversus-host disease among allogeneic transplant recipients (SR-H).	assess infection
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32774	Differential diagnosis for infection of skin lesions should include bacterial, fungal, viral and parasitic agents (SR-H).	Differential diagnosis for infection of skin lesions should include bacterial, fungal, viral and parasitic agents	perform differential diagnosis	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32775	Biopsy or aspiration of the lesion to obtain material for histologic and microbiologic evaluation should always be implemented as an early diagnostic step (SR-H).	implement biopsy or aspiration of the lesion to obtain material for histologic and microbiologic evaluation as an early diagnostic step	implement	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32776	Determine whether the current presentation of fever and neutropenia is the patient’s initial episode of fever and neutropenia or a persistent unexplained fever from their initial episode (after 4-7 days), or a subsequent episode of fever and neutropenia (recurrent)	Determine whether the current presentation of fever and neutropenia is the patient’s initial episode of fever and neutropenia or a persistent unexplained fever from their initial episode (after 4-7 days), or a subsequent episode of fever and neutropenia (recurrent)	determine
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32777	Aggressively determine the etiology of the skin and soft tissue infection by aspiration and/or biopsy of skin and soft tissue lesions and submit these for thorough cytologic/histologic assessments, microbial staining and cultures	aggressively determine the etiology of the skin and soft tissue infection by aspiration and/or biopsy of skin and soft tissue lesions	determine
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32777	Aggressively determine the etiology of the skin and soft tissue infection by aspiration and/or biopsy of skin and soft tissue lesions and submit these for thorough cytologic/histologic assessments, microbial staining and cultures	submit these for thorough cytologic/histologic assessments, microbial staining, and cultures	submit
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32778	Risk-stratify patients with fever and neutropenia according to susceptibility to infection: high-risk patients are those with anticipated prolonged (>7 days) and profound neutropenia (ANC <100 cells/?L) or with a Multinational Association for Supportive Care (MASCC) score of <21; low-risk patients are those with anticipated brief (<7 days) periods of neutropenia and few comorbidities or with a MASCC of ?21	Risk-stratify patients with fever and neutropenia according to susceptibility to infection: high-risk patients are those with anticipated prolonged (>7 days) and profound neutropenia (ANC <100 cells/?L) or with a Multinational Association for Supportive Care (MASCC) score of <21; low-risk patients are those with anticipated brief (<7 days) periods of neutropenia and few comorbidities or with a MASCC of ?21	risk-stratify
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32779	Determine the extent of infection through a thorough physical examination, blood cultures, chest radiograph and additional imaging (including chest CT)	Determine the extent of infection through a thorough physical examination
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32779	Determine the extent of infection through a thorough physical examination, blood cultures, chest radiograph and additional imaging (including chest CT)	Determine the extent of infection through blood cultures,
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32779	Determine the extent of infection through a thorough physical examination, blood cultures, chest radiograph and additional imaging (including chest CT)	Determine the extent of infection through chest radiograph
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32779	Determine the extent of infection through a thorough physical examination, blood cultures, chest radiograph and additional imaging (including chest CT)	Determine the extent of infection through additional imaging (including chest CT)
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32780	Hospitalization and empiric antibacterial therapy with vancomycin plus antipseudomonal antibiotics such as cefepime, a carbapenem (imipenem-cilastatin or meropenem or doripenem) or piperacillintazobactam are recommended	hospitalize	hospitalize	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32780	Hospitalization and empiric antibacterial therapy with vancomycin plus antipseudomonal antibiotics such as cefepime, a carbapenem (imipenem-cilastatin or meropenem or doripenem) or piperacillintazobactam are recommended	perform empiric antibacterial therapy with vancomycin plus antipseudomonal antibiotics such as cefepime, a carbapenem (imipenem-cilastatin or meropenem or doripenem) or piperacillintazobactam	perform empiric antibacterial therapy	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32781	Documented clinical and microbiologic skin and soft tissue infections should be treated based on antimicrobial susceptibilities of isolated organisms	treat based on antimicrobial susceptibilities of isolated organisms
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32782	The treatment duration for most bacterial skin and soft tissue infections should be 7-14 days	treatment duration should be 7-14 days
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32783	Surgical intervention is recommended for drainage of soft-tissue abscess after marrow recovery or for a progressive polymicrobial necrotizing fasciitis or myonecrosis	perform surgical intervention for drainage of soft-tissue abscess after marrow recovery or for a progressive polymicrobial necrotizing fasciitis or myonecrosis	perform surgical procedure	recommend
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32784	Adjunct colony-stimulating factor therapy (G-CSF, GM-CSF) or granulocyte transfusions	do not perform adjunct colony-stimulating factor therapy (granulocyte colony-stimulating factor, granulocyte macrophage colony-stimulating factor)
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32784	Adjunct colony-stimulating factor therapy (G-CSF, GM-CSF) or granulocyte transfusions	granulocyte transfusions
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32785	Acyclovir should be administered to patients suspected or confirmed to have cutaneous or disseminated herpes simplex (HSV) or varicella zoster virus (VZV) infection (SR-M).	administer acyclovir	administer	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32786	Yeasts and molds remain the primary cause of infection-associated fever and neutropenia. Therefore, empiric antifungal therapy (Table 5) should be added to the antibacterial regimen (SR-H).	add empiric antifungal therapy to the antibacterial regimen
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32787	Empiric administration of vancomycin or other agents with Gram-positive activity (linezolid, daptomycin or ceftaroline) should be added if not already being administered	add empiric administration of vancomycin or other agents with Gram-positive activity (linezolid, daptomycin or ceftaroline)
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32788	Candida species skin and soft tissue infections should be treated with an echinocandin or, if Candida parapsilosis has been isolated, lipid formulation amphotericin-B (SR-H)	treated with an echinocandin
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32788	Candida species skin and soft tissue infections should be treated with an echinocandin or, if Candida parapsilosis has been isolated, lipid formulation amphotericin-B (SR-H)	if Candida parapsilosis has been isolated, lipid formulation amphotericin-B
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32789	if Candida parapsilosis has been isolated treat with fluconazole as an acceptable alternative to lipid formulation amphotericin-B	treat with fluconazole as an acceptable alternative to lipid formulation amphotericin-B
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32790	Treatment should be for 2 weeks after clearance of blood stream infection or resolution of skin lesions.	treat for 2 weeks after clearance of blood stream infection or resolution of skin lesions	treat	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32791	Aspergillus skin and soft tissue infections should be treated with voriconazole	treat with voriconazole	treat	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32792	alternatively to voriconazole treat Aspergillus skin and soft tissue infections with lipid formulations of amphotericin B, posaconazole or echinocandin for 6-12 weeks	treat with lipid formulations of amphotericin B, posaconazole, or echinocandin for 6-12 weeks
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32793	Mucor/Rhizopus infections should be treated with lipid formulation amphotericin B	treat with lipid formulation amphotericin B	treat	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32794	Mucor/Rhizopus infections should be treated with posaconazole	treat with posaconazole	treat	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32795	The addition of an echinocandin could be considered based on synergy in murine models of mucormycosis and observational clinical data (WR-L).	add echinocandin
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32796	Fusarium species infections should be treated with high-dose IV voriconazole or posaconazole	treat with high-dose IV voriconazole or posaconazole	treat	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32797	Begin treatment for antibiotic-resistant bacterial organisms (Table 6) in patients currently on antibiotics.	begin treatment for antibiotic-resistant bacterial organisms	treat
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32798	Intravenous acyclovir should be added to the patient’s antimicrobial regimen for suspected or confirmed cutaneous or disseminated HSV or VZV infections (SR-M).	add intravenous acyclovir to the patient’s antimicrobial regimen	add	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32799	Blood cultures should be obtained, and skin lesions in this population of patients should be aggressively evaluated by culture aspiration, biopsy or surgical excision since they may be caused by resistant microbes, yeast or molds	obtain blood cultures	obtain	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32799	Blood cultures should be obtained, and skin lesions in this population of patients should be aggressively evaluated by culture aspiration, biopsy or surgical excision since they may be caused by resistant microbes, yeast or molds	aggressively evaluate skin lesions by culture aspiration, biopsy, or surgical excision	evaluate	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32800	Polymerase chain reaction (PCR) in peripheral blood for HSV and VZV might be helpful in establishing a diagnosis of disseminated infection in patients with unexplained skin lesions (WR-M).	use polymerase chain reaction in peripheral blood for herpes simplex virus and varicella zoster virus to establish a diagnosis of disseminated infection	use	might
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32801	Consider immediate consultation with a dermatologist familiar with cutaneous manifestations of infection in patients with cellular immune defects (eg, those with lymphoma, lymphocytic leukemia, recipients of organ transplants, or those receiving immunosuppressive drugs such as anti-tumor necrosis factors or certain monoclonal antibodies)	Consider immediate consultation with a dermatologist familiar with cutaneous manifestations of infection	consult	consider
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32802	Consider biopsy and surgical debridement early in the management of these patients	perform biopsy
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32802	Consider biopsy and surgical debridement early in the management of these patients	perform surgical debridement
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32803	Empiric antibiotics, antifungals and/or antivirals should be considered	use empiric antibiotics, antifungals and/or antivirals	use	should
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update	32804	The use of specific agents should be decided with the input of the primary team, dermatology, infectious disease and other consulting teams	The use of specific agents should be decided with the input of the primary team, dermatology, infectious disease, and other consulting teams	decide	should