| 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. | 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. | 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated Pneumonia | 32661 | In patients with VAT, we suggest not providing antibiotic therapy | do not provide antibiotic therapy | provide | suggest |
| Hospital-Acquired and Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated Pneumonia | 32665 | If empiric coverage for MRSA is indicated, we recommend either vancomycin or linezolid | treat with vancomycin | treat | recommend |
| Hospital-Acquired and Ventilator-Associated Pneumonia | 32665 | If empiric coverage for MRSA is indicated, we recommend either vancomycin or linezolid | treat with linezolid | treat | recommend |
| Hospital-Acquired and Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated Pneumonia | 32687 | For patients with HAP/VAP due to P. aeruginosa, we recommend against aminoglycoside monotherapy | against treating with aminoglycoside monotherapy | ||
| Hospital-Acquired and Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 Ventilator-Associated 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 |