Recs – SNOMED CT Codes

Demonstration of identifying an extended set of SNOMEDCT codes to identify key concepts in each recommendation.
ID Recommendation All CUI codes
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. C0004927,C0019664,C0030705,C0031809,C0150618,C0205485,C0263955,C0420160,C0449258,C0521110,C0884358,C1301820,C1527148,C1882120,C4321457,C0012634,C0018799,C0031809,C0262926
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. C0007193,C0007930,C0011900,C0015576,C0019664,C0030705,C0241888,C0241889,C0264795,C0340427,C0420612,C0700124,C0878544,C1301820,C1837350,C1882120,C2364239,C3532251,C0011900,C0033141,C0241889,C0262926,C0878544
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. C0001876,C0013604,C0030705,C0043100,C0085619,C0085649,C0205100,C0232133,C0348013,C0428897,C0449438,C0449468,C0582950,C0750572,C1516048,C1882095,C1947978,C3146287,C0013604,C0085619,C0085649,C0311392,C0392148,C0428897,C0460139,C1261322
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. C0005767,C0005771,C0005773,C0006675,C0007584,C0007634,C0009555,C0010294,C0013832,C0015663,C0017725,C0019932,C0022877,C0023767,C0023779,C0023884,C0023901,C0024467,C0028158,C0030705,C0036792,C0041942,C0042014,C0202004,C0202041,C0202230,C0205197,C0205265,C0220825,C0229671,C0232741,C0242485,C0427433,C0428282,C0430044,C0438244,C0587355,C0600061,C0600137,C0700225,C0733758,C0750480,C0005767,C0005771,C0005773,C0005845,C0006675,C0007584,C0007634,C0009555,C0010294,C0013832,C0015663,C0017725,C0019932,C0023779,C0023884,C0023901,C0024467,C0028158,C0040132,C0040135,C0040160,C0041942,C0042014,C0201976,C0229671,C0430044,C0587355,C0600137,C1261322,C1269647,C1278929,C1291218
32475 Serial monitoring, when indicated, should include serum electrolyte levels and renal function. C0013832,C0229671,C0232804,C0428284,C1287347,C1444656,C3536863,C0013832,C0181904,C0229671,C1287347,C2946261
32476 A 12-lead electrocardiogram should be performed initially on all patients presenting with Heart Failure C0013798,C0023175,C0030705,C0179504,C0199557,C0205265,C0444868,C0884358,C2960418,C0013798,C0023175,C1623258
32477 Screening for hemochromatosis or HIV is reasonable in selected patients who present with Heart Failure. C0018995,C0019682,C0030705,C0150312,C1303095,C1710032,C0018995,C0220908
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. C0002726,C0012634,C0030705,C0031511,C0205210,C0242114,C0348026,C0002726,C0012634,C0031511
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. C0006558,C0007226,C0030705,C0030956,C0035647,C0081880,C0205091,C0205314,C0332283,C0388060,C0442709,C0489485,C0597421,C0749225,C0871489,C1273070,C1277187,C1522565,C1527148,C1562095,C1611835,C1710032,C1997351,C3266750,C3266752,C3266753,C3532309,C3532310,C3532311,C3827682,C3887460,C3887504,C0030956,C0220908,C1273070,C1277187
32480 In patients presenting with dyspnea, measurement of natriuretic peptide biomarkers is useful to support a diagnosis or exclusion of Heart Failure. C0006558,C0011900,C0013404,C0030705,C0030956,C0081880,C0242485,C0388060,C0597421,C1095989,C1446047,C2828389,C3827682,C4518809,C0011900,C0013404,C0030956
32481 Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic Heart Failure. C0012634,C0205191,C0242485,C0278252,C2364239,C3827682,C0012634,C0033325
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. C0006558,C0019994,C0030956,C0041199,C0081880,C0184666,C0205434,C0242485,C0278252,C0388060,C0443211,C0457453,C0559269,C0597421,C1305957,C1442488,C3827682,C4035588,C4533677,C0030956,C0033325,C0041199,C0184666,C2946261
32483 During a Heart Failure hospitalization, a predischarge natriuretic peptide level can be useful to establish a postdischarge prognosis. C0006558,C0019993,C0030956,C0081880,C0278252,C0347984,C0388060,C0443211,C0597421,C2946261,C3827682,C0030956,C0033325,C2946261
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. C0016059,C0030705,C0035647,C0205191,C0205394,C0242485,C0442796,C0750591,C1514983,C1522564,C0016059,C0449210,C3263722,C3263723
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. C0012634,C0018787,C0030705,C0205178,C0205314,C0205394,C0205434,C0242073,C0456389,C0700148,C0817096,C1330713,C1457887,C1516048,C1523987,C1997218,C0012634,C0018787,C0018799,C0039985,C0242073,C0449210,C0700148,C0817096,C1281570,C1306645,C1457887,C1962945
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. C0013516,C0026597,C0030705,C0080310,C0080311,C0205265,C0220825,C0347984,C0436484,C0456389,C0588136,C0743380,C0884358,C1516048,C1522565,C1705052,C2243117,C0013516,C0554756,C1261322
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. C0017366,C0030705,C0085268,C0205210,C0205341,C0232164,C0242485,C0441471,C0449438,C0449440,C0678594,C0699733,C0729795,C0746919,C0750502,C1280500,C1514756,C1533716,C1709850,C3827682,C0087111
32488 Noninvasive imaging to detect myocardial ischemia and viability is reasonable in patients presenting with de novo Heart Failure, who have known CAD and no angina, unless the patient is not eligible for revascularization of any kind. C0022116,C0030705,C0151744,C0205309,C0472662,C0472666,C0472667,C0472672,C0581603,C1330713,C1522564,C1548635,C1552551,C2986496,C0002962,C0011923,C0022116,C0151744,C0581603
32489 Viability assessment is reasonable in select situations when planning revascularization in Heart Failure patients with CAD. C0030705,C0472662,C0472666,C0472667,C0472672,C0581603,C1651012,C0581603,C1261322
32490 Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate. C0013516,C0024485,C0034610,C0449468,C0596683,C0846023,C1516048,C3827682,C0011923,C0013516,C0024485,C0034610,C0231881
32491 Magnetic resonance imaging is reasonable when assessing myocardial infiltrative processes or scar burden. C0024485,C1522564,C2828008,C0011923,C0024485,C0231881,C2004491
32492 Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should NOT be performed. C0205210,C0205341,C0205547,C0242485,C0442739,C0445106,C0449438,C0449440,C0746919,C0884358,C2732244,C1261322,C1273869,C1689985
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. C0019010,C0030705,C0150264,C0179732,C0183290,C0190658,C0199629,C0205210,C0205281,C0221099,C0226054,C0226069,C0231303,C0476273,C0521095,C0521346,C0884358,C0919772,C1827218,C1828314,C1979886,C3882333,C3887511,C4082936,C0003842,C0031001,C0034052,C0085590,C0087111,C0150264,C0161959,C0179790,C0181904,C0302614,C0460139,C0476273,C0729936,C1261322,C1269026
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. C0001876,C0019010,C0027552,C0030705,C0040732,C0042380,C0087130,C0150264,C0205178,C0205251,C0205265,C0205281,C0205322,C0205373,C0232804,C0332281,C0426068,C0428971,C0429119,C0449438,C0456261,C0489485,C0518609,C0871470,C0919772,C1457887,C1801960,C1880496,C1882095,C1980011,C3827682,C4082936,C4281815,C0031001,C0040732,C0087111,C0150264,C0161959,C0181904,C0183683,C0344211,C0450442,C0460139,C1457887
32495 When ischemia may be contributing to Heart Failure, coronary arteriography is reasonable for patients eligible for revascularization. C0003844,C0022116,C0030705,C0436418,C0436469,C0436525,C0472662,C0472666,C0472667,C0472672,C0565183,C0565184,C0581603,C1445885,C1522318,C1548635,C1880177,C0003844,C0022116,C0085532,C0581603
32496 Endomyocardial biopsy can be useful in patients presenting with Heart Failure when a specific diagnosis is suspected that would influence therapy. C0005558,C0011900,C0030705,C0189785,C1997218,C3827682,C4054723,C0005558,C0011900,C0087111,C0189785
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. C0012798,C0019010,C0030705,C0150264,C0205178,C0205281,C0205434,C0205547,C0231220,C0700148,C0919772,C1820977,C3846195,C3846199,C4082936,C4282382,C0012798,C0042402,C0150264,C0161959,C0181904,C0522563,C0700148,C2712122
32498 Endomyocardial biopsy should NOT be performed in the routine evaluation of patients with Heart Failure. C0005558,C0030705,C0189785,C0205547,C0220825,C0445106,C0884358,C0005558,C0189785,C1261322
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. C0011847,C0011849,C0023175,C0028754,C0040329,C0205309,C0205318,C0205394,C0332298,C1956032,C3853727,C0011849,C0028754,C0040329,C0449210,C0450442
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. C0003006,C0003009,C0003012,C0003015,C0003018,C0014442,C0019664,C0030705,C0034787,C0039082,C0201888,C0205157,C0205178,C0231200,C0231220,C0243077,C0332185,C0340678,C0392756,C0444868,C0597357,C0948089,C1272105,C1444657,C1522318,C1548787,C1873000,C0003015,C0003018,C0014442,C0022709,C0034787,C0039082,C0262926,C0597357,C0948089
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. C0019664,C0030705,C0039082,C0205157,C0205178,C0332185,C0340678,C0392756,C0444868,C0948089,C1522318,C3887511,C0039082,C0262926,C0948089
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. C0007226,C0019664,C0030705,C0039082,C0205157,C0205178,C0231220,C0332185,C0340678,C0441471,C0444868,C0948089,C1522318,C3887460,C0039082,C0262926,C0360714,C0948089,C1320716
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. C0001876,C0005767,C0005823,C0015393,C0017366,C0019664,C0020564,C0030705,C0162791,C0205210,C0205318,C0231220,C0332298,C0445199,C0564627,C0678594,C1882095,C1963138,C2748577,C3809765,C0005767,C0020538,C0020564,C0149721,C0262926,C0460139,C1272641,C1689985
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. C0019664,C0030705,C0231220,C0243077,C0392756,C0444868,C0003015,C0262926
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. C0019664,C0030705,C0231220,C0392756,C0444868,C0262926
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. C0007930,C0011071,C0030705,C0205170,C0205245,C0205476,C0231221,C0349782,C0418981,C0439234,C0439509,C0449438,C0451175,C0475224,C0679138,C0687676,C0878544,C1524072,C1548787,C1837350,C3842587,C3842588,C0011071,C0087111,C0231221,C0349782,C0418981,C0441587,C0878544,C1306577,C1533810
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. C0006675,C0030705,C0205160,C0205251,C0231221,C0231918,C0439799,C0573229,C1280500,C1457887,C1704420,C0006675,C0006684,C0231221,C1457887
32510 Patients with Heart Failure should receive specific education to facilitate Heart Failure self-care. C0030705,C0036588,C1514756,C0013658,C0039401,C0424927
32511 Sodium restriction is reasonable for patients with symptomatic Heart Failure to reduce congestive symptoms. C0030705,C0037473,C0150136,C0231220,C0430141,C0742742,C1457887,C0037473,C1457887
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. C0015259,C0026606,C0030705,C0184511,C0205245,C0205272,C0205485,C0220931,C0449438,C0451175,C1704419,C1820977,C3845261,C3846195,C3846199,C0220931
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. C0015259,C0018684,C0026643,C0030705,C0184511,C0205245,C0332306,C0376558,C0700431,C1516240,C1998319,C2926735,C3827682,C0034991,C0518214,C0700431,C1998319,C2926735
32516 Heart FailurerEF NYHA class I?IV (Stage C) ACEI or ARB AND GDMT beta blocker; diuretics as needed (COR I) C0012798,C0456387,C1306673,C1883728,C0012798,C0028778
32517 NYHA class II?IV, provided est. CrCl >30 mL/min & K+ <5.0 mEq/L implement Aldosterone antagonist (COR I) C0002006,C0002007,C0439152,C0439445,C0439526,C0456387,C3661900,C3842588,C0002006,C0002007
32520 NYHA class II?III, LVEF ?35%; (caveat: >1 y survival, >40 d post MI) implement implantable cardioverter-defibrillator C0180307,C0439509,C0456387,C0687676,C1289801,C1960586,C3842587,C4319605,C0162589,C0180307
32522 NYHA class II?III, NSR, heart rate ?70 bpm on maximally tolerated dose beta blocker C0018787,C0018810,C0456387,C1521828,C3842584,C0018787,C0028778,C1281570
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 C0030231,C0030705,C0181598,C0205091,C0456387,C0699733,C0750591,C1285530,C1306673,C1517586,C1522565,C1524062,C1960585,C3841811,C0030231,C0040732,C0085842,C0087111,C0181598,C0332835
32524 Diuretics are recommended in patients with Heart FailurerEF with fluid retention C0012798,C0030705,C0268000,C1820977,C3532160,C3846195,C3846199,C0012798,C0268000
32525 ACE inhibitors are recommended for all patients with Heart FailurerEF C0030705,C0243077,C0444868,C1820977,C3846195,C3846199,C0003015
32526 ARBs are recommended in patients with Heart FailurerEF who are ACE inhibitor–intolerant C0030705,C0231200,C1820977,C1999216,C3846195,C3846199,C0003015
32529 Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with Heart FailurerEF. C0002006,C0002007,C0030705,C0205195,C0205547,C1999216,C0002006,C0002007,C0003015
32531 Aldosterone receptor antagonists are recommended in patients with NYHA class II–IV Heart Failure who have LVEF ?35% C0002006,C0030705,C0243076,C0456387,C0522271,C0597357,C1820977,C3846195,C3846199,C4319605,C0002006,C0002007,C0597357
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. C0002006,C0009488,C0011847,C0011849,C0019664,C0030705,C0205178,C0243076,C0332282,C0439509,C0522271,C0597357,C1313937,C1444657,C1457887,C1820977,C3532488,C3532489,C3842587,C3846195,C3846199,C0002006,C0002007,C0011849,C0262926,C0597357,C1457887
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. C0002006,C0010294,C0016107,C0017654,C0020461,C0032821,C0229671,C0231179,C0232809,C0243076,C0376558,C0428282,C0438244,C0439152,C0439269,C0439445,C0439526,C0522271,C0597357,C0600061,C0700225,C0750572,C1301862,C1521828,C1548788,C2826244,C3842588,C4321396,C0002006,C0002007,C0010294,C0017654,C0020461,C0032821,C0035078,C0201976,C0229671,C0597357
32534 The combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III–IV Heart FailurerEF on GDMT C0020223,C0022251,C0022252,C0052142,C0054603,C0456387,C1820977,C3846195,C3846199,C0020223,C0022251,C0022252
32535 A combination of hydralazine and isosorbide dinitrate can be useful in patients with Heart FailurerEF who cannot be given ACE inhibitors or ARBs C0020223,C0022251,C0022252,C0030705,C0052142,C0054603,C0243077,C1442162,C3827682,C0003015,C0020223,C0022251,C0022252
32536 Digoxin can be beneficial in patients with Heart FailurerEF, unless contraindicated, to decrease hospitalizations for Heart Failure. C0012265,C0019993,C0030705,C0547047,C1444657,C0012265
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). C0001779,C0003280,C0007787,C0011847,C0011849,C0019664,C0030705,C0035647,C0035648,C0079164,C0150457,C0205156,C0205191,C0205311,C0205322,C0205355,C0341425,C0439234,C0449867,C0475224,C0852649,C1317264,C1446238,C1514756,C1521761,C1524062,C1531624,C1963138,C1998164,C2748577,C3173979,C3536711,C3843647,C4319621,C4505286,C0003280,C0007787,C0011849,C0020538,C0038454,C0087111,C0150457,C0262926,C1304680,C1531624
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. ( C0003280,C0030705,C0035647,C0040223,C0043031,C0205210,C0205311,C0205322,C0205355,C0205394,C0242784,C0302350,C0332310,C0450442,C0455939,C0456603,C0460096,C0460097,C0460099,C0525032,C0558295,C0687133,C1512888,C1514721,C1521970,C1739768,C1831808,C1874451,C1881197,C1882115,C2348066,C2986790,C3245505,C3274448,C3536711,C0003280,C0013227,C0043031,C0449210,C0450442,C0525032,C1739768,C1831808,C1874451
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). ( C0030705,C0035647,C0035648,C0079164,C0205191,C0205311,C0205322,C0205355,C0332288,C0449867,C0852649,C1317264,C1521761,C1524062,C1531624,C3173979,C4505286,C0038454,C1531624
32540 Anticoagulation is NOT recommended in patients with chronic Heart FailurerEF without AF, a prior thromboembolic event, or a cardioembolic source C0030705,C0205191,C0332288,C0333214,C0441471,C0449416,C0449867,C1820977,C3846195,C3846199,C0449416
32541 Statins are NOT beneficial as adjunctive therapy when prescribed solely for Heart Failure C0278329,C1292783,C0087111,C0360714
32543 Nutritional supplements as treatment for Heart Failure are NOT recommended in patients with current or prior symptoms of Heart FailurerEF. ( C0030705,C0746919,C1457887,C1521739,C1820977,C3846195,C3846199,C1457887
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). C0006675,C0030705,C0051696,C0205210,C0205309,C0205393,C0332149,C0332206,C0333348,C0424092,C0439799,C0449438,C0449440,C1257987,C1457887,C3537142,C0003195,C0006675,C0013227,C0051696,C1257987,C1457887
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 C0012634,C0030705,C0205088,C0205166,C0205476,C0444930,C0746919,C0849833,C1306673,C1446409,C0012634,C0013227,C0354668
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. C0002006,C0003006,C0003009,C0003012,C0003018,C0009488,C0030705,C0035094,C0205191,C0205210,C0243076,C0243077,C0449913,C0679199,C1820977,C1873000,C2699427,C3463820,C3846195,C3846199,C3887511,C0002006,C0002007,C0003015,C0003018,C0035094,C1960108
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. C0002006,C0003006,C0003009,C0003012,C0003018,C0009488,C0030705,C0035094,C0205191,C0205210,C0243076,C0449913,C0679199,C1820977,C1873000,C2699427,C3463820,C3846195,C3846199,C3887511,C0002006,C0002007,C0003018,C0035094
32550 The use of ACE inhibitors is beneficial for patients with prior or current symptoms of chronic Heart FailurerEF to reduce morbidity and mortality. C0009488,C0030705,C0205191,C0243077,C1457887,C0003015,C1457887
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. C0002994,C0009488,C0030705,C0205191,C0231200,C0243077,C1457887,C1820977,C3846195,C3846199,C0002994,C0003015,C0010200,C1457887
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. C0009488,C0030705,C0205191,C0231220,C0456387,C0559956,C1517331,C1820977,C1999216,C3846195,C3846199,C0003015,C0035139
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. C0003006,C0003009,C0003012,C0003018,C0025250,C0034787,C0243077,C0332285,C0439227,C0564385,C0597357,C1517741,C1548562,C1873000,C1999216,C4319606,C0003015,C0003018,C0034787,C0597357
32554 Angiotensin receptor-neprilysin inhibitor should not be administered to patients with a history of angioedema. C0002994,C0003006,C0003009,C0003012,C0003018,C0019664,C0025250,C0030705,C0034787,C0597357,C1548562,C1873000,C1999216,C3266719,C0002994,C0003018,C0034787,C0262926,C0597357
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. C0018787,C0018810,C0019993,C0030705,C0035253,C0205191,C0231220,C0232201,C0257190,C0456387,C0806909,C0871269,C1319902,C1521828,C3842584,C4319605,C0016169,C0018787,C0028778,C0232201,C0257190,C0423772,C1281570
32556 Diuretics are recommended in patients with Heart FailurerEF who have evidence of fluid retention, unless contraindicated, to improve symptoms. C0012798,C0030705,C0184511,C0268000,C1444657,C1457887,C1820977,C3532160,C3846195,C3846199,C3887511,C0012798,C0268000,C1457887
32557 ACE inhibitors are recommended in patients with Heart FailurerEF and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality. C0009488,C0030705,C0243077,C1444657,C1457887,C1820977,C3846195,C3846199,C0003015,C1457887
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. C0009488,C0030705,C0231200,C1444657,C1457887,C1820977,C1999216,C3846195,C3846199,C0003015,C1457887
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. C0009488,C0030705,C0205394,C0243077,C1444657,C2093656,C0003015,C0087111,C0449210
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. C0002006,C0002007,C0030705,C0231220,C0750508,C0750591,C1444655,C1444656,C1999216,C0002006,C0002007,C0003015,C0028778
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. C0009488,C0025859,C0030705,C0038617,C0053799,C0054836,C0220918,C0443318,C0444868,C0724633,C1444657,C1457887,C1820977,C3846195,C3846199,C0025859,C0053799,C0054836,C0220918,C0724633,C1457887,C1963578,C2732140
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. C0002006,C0006558,C0007226,C0009488,C0010294,C0012798,C0016107,C0017654,C0019664,C0019993,C0020461,C0026160,C0030705,C0030956,C0032105,C0032821,C0035647,C0081880,C0231179,C0232804,C0232809,C0243076,C0332283,C0388060,C0439152,C0439269,C0439445,C0439526,C0456387,C0522271,C0597357,C0597421,C0750572,C0750591,C0884358,C1301862,C1444657,C1521828,C1704686,C1820977,C3163633,C3842588,C3846195,C3846199,C3887460,C4319605,C4321396,C0002006,C0002007,C0010294,C0012798,C0017654,C0020461,C0030956,C0032105,C0032821,C0035078,C0181904,C0262926,C0597357,C2946261
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. C0009488,C0020223,C0022251,C0022252,C0030705,C0052142,C0054603,C0243077,C0456387,C1444657,C1820977,C3846195,C3846199,C0003015,C0020223,C0022251,C0022252,C0087111
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. C0009269,C0009488,C0020223,C0020649,C0022251,C0022252,C0030705,C0052142,C0054603,C0231179,C0231220,C0277585,C1442162,C1444657,C1999216,C3827682,C0003015,C0013227,C0020223,C0020649,C0022251,C0022252,C0035078,C0277585
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. C0003280,C0030705,C0035647,C0040223,C0043031,C0205210,C0205311,C0205322,C0205355,C0205394,C0242784,C0302350,C0332310,C0450442,C0455939,C0456603,C0460096,C0460097,C0460099,C0525032,C0558295,C0687133,C1512888,C1514721,C1521970,C1739768,C1831808,C1874451,C1881197,C1882115,C2348066,C2986790,C3245505,C3274448,C3536711,C0003280,C0013227,C0043031,C0449210,C0450442,C0525032,C1739768,C1831808,C1874451
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). C0030705,C0035647,C0035648,C0079164,C0205191,C0205311,C0205322,C0205355,C0332288,C0449867,C0852649,C1317264,C1521761,C1524062,C1531624,C3173979,C4505286,C0038454,C1531624
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) C0030705,C0205191,C0332288,C0333214,C0441471,C0449416,C0449867,C0814225,C1820977,C3846195,C3846199,C0449416
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. C0011900,C0205394,C0278329,C1292783,C2093656,C0011900,C0087111,C0360714,C0449210,C1689985
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. C0001128,C0007226,C0015684,C0019993,C0030705,C0032615,C0242296,C0452290,C0452291,C0452293,C0456387,C0556056,C0556077,C0556088,C0556095,C0556123,C1292783,C1444657,C1457887,C1719844,C2362518,C3887460,C0001128,C0015684,C0015689,C0032615,C0087111,C1457887
32575 Nutritional supplements as treatment for Heart Failure are NOT recommended in patients with current or prior symptoms of Heart FailurerEF. C0030705,C0746919,C1457887,C1521739,C1820977,C3846195,C3846199,C1457887
32576 Hormonal therapies other than to correct deficiencies are NOT recommended for patients with current or prior symptoms of Heart FailurerEF. C0030705,C0205394,C0458083,C1457887,C1820977,C3846195,C3846199,C1457887
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). C0012634,C0030705,C0034866,C0205088,C0205166,C0205476,C0444930,C0746919,C0849833,C1306673,C1446409,C1947903,C0012634,C0013227,C0354668
32579 Calcium channel–blocking drugs are NOT recommended as routine treatment for patients with Heart FailurerEF. C0006675,C0030705,C0205547,C0332206,C0439799,C0746919,C1820977,C3846195,C3846199,C0006675,C0013227
32580 Systolic and diastolic blood pressure should be controlled in patients with Heart FailurepEF in accordance with published clinical practice guidelines to prevent morbidity. C0001876,C0005767,C0005823,C0009488,C0030705,C0162791,C0205210,C0205318,C0332298,C0428883,C0442709,C0445199,C0489485,C0564627,C1882095,C0005767,C0460139,C1272641
32581 Diuretics should be used for relief of symptoms due to volume overload in patients with Heart FailurepEF. C0012798,C0030705,C0449468,C1457887,C3146286,C0012798,C0564405,C1457887
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. C0022116,C0030705,C0151744,C0231220,C0332265,C0472662,C0472666,C0472667,C0472672,C0581603,C1280500,C1457887,C1522318,C1522564,C0002962,C0022116,C0151744,C0581603,C1457887
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. C0001876,C0005767,C0005823,C0030705,C0243077,C0332206,C1882095,C1963138,C2748577,C0003015,C0005767,C0020538,C0450442,C0460139,C1272641
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. C0002006,C0010294,C0016107,C0017654,C0019993,C0030705,C0032821,C0232809,C0243076,C0332285,C0439152,C0439234,C0439269,C0439445,C0439526,C0457453,C0522271,C0547047,C0559269,C0597357,C0750572,C0750591,C1521828,C3163633,C3842588,C4321396,C4533677,C0002006,C0002007,C0010294,C0017654,C0032821,C0597357,C2946261
32587 Routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QoL in patients with Heart FailurepEF is ineffective. C0028125,C0030705,C0045231,C0070828,C0205547,C0243077,C0442805,C3242229,C3845261,C0028125
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) C0012634,C0018787,C0018799,C0030705,C0033144,C0085298,C0150223,C0205191,C0205225,C0439234,C0439509,C0439810,C0456387,C0475224,C0475676,C0679138,C0687676,C0740220,C0848343,C0946217,C1457887,C1510446,C1820977,C3494324,C3842587,C3846195,C3846199,C4319605,C0011071,C0012634,C0018787,C0018799,C0033144,C0085298,C0087111,C0151744,C0199176,C0439631,C1281570,C1306577,C1457887
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. C0006384,C0023211,C0030705,C0085615,C0205091,C0225917,C0232201,C0456387,C0871269,C1253959,C1444656,C1457887,C1704243,C2926735,C4319605,C0006384,C0016169,C0023211,C0028778,C0087111,C0225917,C0232201,C0423772,C1457887,C2926735
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. C0030705,C0033144,C0150223,C0205172,C0205225,C0439234,C0439509,C0439810,C0456387,C0679138,C0687676,C0750519,C0946217,C1457887,C1820977,C3494324,C3842587,C3842588,C3846195,C3846199,C0033144,C0087111,C0199176,C0439631,C1457887
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. C0030705,C0232201,C0449774,C0456387,C0871269,C1457887,C2926735,C3827682,C4319605,C0016169,C0232201,C0423772,C1457887,C2926735
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. C0030705,C0232201,C0456387,C0871269,C1457887,C2926735,C3827682,C4319550,C4319605,C0016169,C0232201,C0423772,C1457887,C2926735
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. C0004245,C0030705,C0205464,C0225924,C0243161,C0428912,C0429115,C0547070,C1521828,C1522565,C1706276,C3272404,C3817553,C3827682,C4319605,C0308718,C0547070
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. C0030705,C0205314,C0429115,C0439509,C0559956,C0699733,C0750502,C1446530,C1514873,C1522565,C1524072,C3272404,C3827682,C3840775,C3842587,C4319605,C0021107,C0035139,C0441587,C1533810
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. C0005698,C0009488,C0019993,C0030705,C0035647,C0087130,C0205250,C0205373,C0332167,C0332183,C0424594,C0426068,C0456040,C0814225,C0946217,C3494324,C3842363,C3887504,C4319571,C0021107,C0424594,C1306459,C1306577
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. C0030705,C0232201,C0449774,C0456387,C0750591,C0871269,C2926735,C4319550,C4319605,C0016169,C0232201,C0423772,C2926735
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. C0030705,C0232201,C0449774,C0456387,C0750591,C0871269,C1457887,C2926735,C4319605,C0016169,C0232201,C0423772,C1457887,C2926735
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. C0030705,C0232201,C0456387,C0475224,C0750591,C0871269,C1314792,C1457887,C2926735,C3842588,C0016169,C0232201,C0423772,C1457887,C2926735
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. C0030705,C0449774,C0456387,C1457887,C1820977,C2926735,C3846195,C3846199,C1457887,C2926735
32601 CRT is NOT indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to <1 year. C0009488,C0030705,C0205170,C0205245,C0424594,C0439234,C1444655,C1444656,C1516240,C1998319,C0424594,C1998319
32602 Fluid restriction (1.5–2 L/d) is reasonable in stage D, especially in patients with hyponatremia, to reduce congestive symptoms. C0020625,C0030705,C0150136,C0204700,C0742742,C1306673,C1457887,C0020625,C0204700,C1457887
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. C0018787,C0018823,C0030705,C0033213,C0036974,C0036980,C0040732,C0205178,C0205373,C0348016,C0443196,C0472662,C0472666,C0472667,C0472672,C0581603,C0597198,C1514756,C1522318,C1720302,C2699488,C4242108,C0018787,C0018823,C0031001,C0033213,C0036974,C0036980,C0040732,C0087111,C0183683,C0344211,C0581603,C1281570
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. C0030705,C0040732,C0348016,C0549178,C0699733,C1306673,C1548635,C0040732,C0087111,C0183683,C0344211,C0456378
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. C0001876,C0005767,C0005823,C0007165,C0008098,C0030705,C0150312,C0178784,C0205251,C0205373,C0348016,C0436599,C0444930,C0476454,C0489485,C0549178,C0597198,C0749225,C1301725,C1806781,C1882095,C3887504,C4055637,C4055638,C0005767,C0020649,C0031001,C0183683,C0344211,C0344315,C0460139,C0749225,C1272641
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. C0030705,C0040732,C0205166,C0348016,C0549178,C0699733,C0750591,C1274136,C1285530,C1306673,C1457887,C1548635,C1651012,C3844638,C0040732,C0087111,C0183683,C0308718,C0344211,C1274136,C1457887
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. C0030231,C0030705,C0205166,C0205267,C0205394,C0348016,C0549178,C1285530,C1446409,C2093656,C3844638,C0030231,C0304509,C0450442,C1689985
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. C0001876,C0005767,C0005823,C0007165,C0008098,C0030705,C0205251,C0221099,C0332288,C0436599,C0476454,C0489485,C0700148,C0749225,C1301725,C1882095,C3887504,C3887511,C4055637,C4055638,C0005767,C0020649,C0031001,C0304509,C0344315,C0450442,C0460139,C0700148,C0749225,C1272641
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. C0002766,C0030705,C0040732,C0443196,C1301732,C1306673,C3840775,C0040732
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. C0019010,C0030705,C0205178,C0439808,C0442087,C0522523,C0679006,C0699733,C0919772,C1522565,C2945640,C0456378
32612 Evaluation for cardiac transplantation is indicated for carefully selected patients with stage D Heart Failure despite GDMT, device, and surgical management. C0002766,C0030705,C0040732,C0220825,C0699733,C1306673,C1444656,C0040732,C0543467,C1261322
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. C0030705,C0039593,C0041199,C0205178,C0205396,C0229671,C0231187,C0278252,C0348080,C1305957,C1548787,C1561607,C0033325,C0041199,C0229671,C0231187,C1623258
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. C0205178,C0205265,C0220825,C0347984,C0678836,C0750591,C1511545,C1548787,C0087111,C1261322
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. C0019010,C0019993,C0024501,C0030705,C0079164,C0205191,C0231220,C0347984,C0746919,C0852649,C0919772,C0948268,C1317264,C1444783,C1820977,C3173979,C3846195,C3846199,C4086268,C4505286,C0948268,C1444783
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. C0012798,C0030705,C0205251,C0348016,C0445550,C0449438,C0449468,C1272703,C1278478,C1704686,C1820977,C2698650,C3846195,C3846199,C0012798,C0028778,C0042402,C0087111,C0304509,C0450442,C0457454
32618 Patients with Heart Failure admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to reduce morbidity. C0009488,C0012798,C0030705,C0348016,C0445022,C0546817,C0750502,C3887511,C4482331,C0012798,C0354100,C0546817
32619 If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose C0012798,C0030705,C0205163,C0205191,C0205265,C0332173,C0348016,C0354100,C0442027,C0445022,C0948575,C0012798,C0087111,C0354100
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. C0005910,C0010294,C0012798,C0013832,C0028158,C0040223,C0041942,C0043100,C0205177,C0205210,C0205373,C0229671,C0242485,C0332173,C0347984,C0348016,C0429791,C0439228,C0444706,C0445247,C0521095,C0600137,C0678756,C0700148,C0746919,C1280500,C1457887,C1512806,C3251814,C4284232,C0010294,C0012798,C0013227,C0013832,C0028158,C0031001,C0041942,C0229671,C0311392,C0587355,C0700148,C1291218,C1457887
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). C0012797,C0012798,C0012802,C0348016,C0445022,C0457385,C0541746,C1457887,C1879523,C3844638,C0012798,C0354100,C1457887
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. C0005767,C0012797,C0012798,C0013030,C0184511,C0205251,C0232338,C0332272,C0354100,C0430118,C0445022,C0445550,C0750591,C0806140,C0948575,C1527409,C0005767,C0012798,C0013030,C0087111,C0354100,C0574032
32623 Ultrafiltration may be considered for patients with obvious volume overload to alleviate congestive symptoms and fluid weight. C0030705,C0043100,C0403573,C0449468,C0742742,C0750591,C1457887,C1963879,C0041612,C1274136,C1457887
32624 Ultrafiltration may be considered for patients with refractory congestion not responding to medical therapy. C0030705,C0205476,C0403573,C0418981,C0700148,C0750591,C1963879,C0041612,C0087111,C0418981,C0700148
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. C0012798,C0013404,C0017887,C0020649,C0028193,C0030705,C0054015,C0205178,C0205434,C0231220,C0332197,C0348016,C0750591,C0948575,C1522673,C4482331,C0001551,C0012798,C0013404,C0017887,C0020649,C0028193,C0054015,C0087111,C0564405
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. C0003280,C0019994,C0030705,C0035647,C0040038,C0182428,C0199242,C0205434,C0348013,C0456603,C0814225,C1514756,C3536711,C3640814,C4035588,C4284232,C4482331,C0003280,C0013227,C0040038,C0199176
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. C0008098,C0009633,C0020625,C0030705,C0035647,C0037473,C0042413,C0043047,C0150136,C0184511,C0205177,C0205322,C0229671,C0243076,C0449468,C0597357,C0750591,C0857122,C1457887,C1516691,C1705480,C1806781,C3537128,C3844638,C0020625,C0037473,C0043047,C0229671,C0457423,C0523891,C0597357,C1457887,C1705480
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 C0002766,C0013832,C0019993,C0019994,C0020649,C0027552,C0030231,C0030705,C0036588,C0085555,C0205191,C0232804,C0332152,C0332282,C0442027,C0443211,C0445111,C0449295,C0449438,C0449468,C0518609,C0522015,C0545082,C0547043,C0586003,C1160864,C1161117,C1275743,C1285530,C1443495,C1444302,C1444399,C1444657,C1527398,C1548175,C1548787,C1704686,C2114533,C2698650,C3871203,C4035588,C4281991,C0012621,C0013658,C0013832,C0020649,C0030231,C0039401,C0085555,C0087111,C0183683,C0344211,C0424927,C0587355,C0589120,C0600083,C0678211,C1261322,C1275743
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. C0002766,C0004927,C0012634,C0019994,C0030705,C0035647,C0205250,C0332167,C1442065,C1705242,C1708476,C1820977,C3484370,C3846195,C3846199,C3872828,C4035588,C4075496,C4319571,C4489276,C0012634,C1303150,C2728259
32631 Scheduling an early follow-up visit (within 7–14 days) and early telephone follow-up (within 3 days) of hospital discharge is reasonable. C0019994,C0039457,C0178941,C0332285,C0545082,C0547043,C0586003,C0589121,C0678742,C1279919,C1548175,C3871203,C4035588,C4281991,C0012621,C0589120,C0600083
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. C0011155,C0015879,C0030705,C0040679,C0184511,C0205245,C0240066,C0302583,C0348016,C0439526,C0449438,C0451175,C0456387,C0559956,C3817553,C3842589,C4319604,C0015879,C0035139,C0040679,C0162429,C0240066,C0302583,C0332155,C0392916,C1277709
32634 In patients with Heart Failure and anemia, erythropoietin-stimulating agents should not be used to improve morbidity and mortality. C0002871,C0009488,C0014822,C0030705,C0184511,C0445107,C0002871,C0014822,C0450442
32635 In patients at increased risk, stage A Heart Failure, the optimal blood pressure in those with hypertension should be <130/80 mm Hg. C0001876,C0005767,C0005823,C0030705,C0035647,C0205217,C1306673,C1882095,C1963138,C2748577,C3842583,C4319552,C0005767,C0020538,C0460139,C1272641
32636 Patients with Heart FailurerEF and hypertension should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg. C0001876,C0005767,C0005823,C0030705,C0278329,C0489485,C1277632,C1282149,C1282150,C1282151,C1282174,C1303018,C1319893,C1319895,C1882095,C1963138,C2748577,C4274438,C4319552,C0005767,C0020538,C0460139,C1272641
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 C0001876,C0002766,C0005767,C0005823,C0030705,C0205322,C0278329,C0449468,C0489485,C1277632,C1282149,C1282150,C1282151,C1282174,C1303018,C1319893,C1319895,C1882095,C1963138,C2748577,C4274438,C4319552,C0005767,C0020538,C0460139,C1272641
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 C0030705,C0037313,C0242114,C0332169,C0393766,C0442802,C0456387,C0522796,C0013144,C0225386,C0917799,C1261322
32639 In patients with cardiovascular disease and obstructive sleep apnea, CPAP may be reasonable to improve sleep quality and daytime sleepiness C0003578,C0007222,C0007226,C0012634,C0030705,C0037313,C0184511,C0205304,C0264656,C0332169,C0332306,C0424563,C0455346,C0455404,C0455539,C0520679,C0849932,C3472692,C3472696,C3873659,C3887460,C0003578,C0007222,C0012634,C0013144,C0037315,C0520679
32640 In patients with NYHA class II–IV Heart FailurerEF and central sleep apnea, adaptive servo-ventilation causes harm C0003578,C0030705,C0037313,C0205099,C0231193,C0456387,C0751762,C3873659,C4050232,C0003578,C0037315,C0520680
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) C0010055,C0012634,C0030705,C0185098,C0205042,C0205091,C0396756,C0472662,C0472666,C0472667,C0472672,C0522523,C0581603,C0741847,C1261287,C1319321,C1320783,C1444656,C1449706,C1522318,C1532338,C1542147,C1550513,C3842586,C3843766,C0002962,C0003842,C0009814,C0010055,C0012634,C0181074,C0185098,C0205042,C0332835,C0440761,C0581603,C0741847,C1261287,C1269008,C1273869
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) C0010055,C0027061,C0030705,C0035067,C0150312,C0184511,C0185098,C0205042,C0205091,C0205094,C0205107,C0205147,C0205386,C0242231,C0396756,C0441998,C0443348,C0472662,C0472666,C0472667,C0472672,C0489485,C0581603,C0729847,C0741847,C0749225,C0750502,C1261287,C1299392,C1319321,C1320783,C1449706,C1522318,C1550513,C3842584,C3842586,C3843766,C3887504,C4319605,C0003842,C0009814,C0010055,C0027061,C0181074,C0185098,C0205042,C0242231,C0332835,C0440761,C0581603,C0741847,C0749225,C1261287,C1269008
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. C0007226,C0009488,C0030705,C0184511,C0205476,C0418981,C0750502,C1301700,C3887460,C3887504,C4319605,C0087111,C0418981
32644 Surgical aortic valve replacement is reasonable for patients with critical aortic stenosis and a predicted surgical mortality of <10%. (IIa-B) C0030705,C0190170,C0190174,C0340373,C0396978,C0396979,C0396980,C0396981,C0396983,C0553904,C0553906,C0559956,C1261287,C1511545,C3266772,C3842590,C0003483,C0003501,C0003506,C0003507,C0009814,C0035139,C0543467,C1261287,C1269005
32645 Transcatheter aortic valve replacement after careful candidate consideration is reasonable for patients with critical aortic stenosis who are deemed inoperable. (IIa-B) C0030705,C0190170,C0190174,C0205187,C0340373,C0396978,C0396979,C0396980,C0396981,C0396983,C0518609,C0553904,C0553906,C0559956,C1261287,C1511545,C3266772,C3509486,C4527371,C0003483,C0003501,C0003506,C0003507,C0009814,C0035139,C1261287,C1269005
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) C0012634,C0018787,C0018799,C0027061,C0030705,C0150312,C0205188,C0443348,C0475224,C0475676,C0489485,C0740220,C0749225,C0750591,C0848343,C1283828,C1510446,C1522318,C3887504,C4319605,C0012634,C0018787,C0018799,C0027061,C0151744,C0749225,C1281570
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. C0026264,C0026266,C0087130,C0205245,C0231179,C0426068,C0442969,C0746591,C0750591,C0814225,C1706907,C2921039,C4319951,C4527371,C0026264,C0026266,C0374711,C0543467,C1269004
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. C0030200,C0030705,C0085268,C0189598,C0750591,C1522565,C1555029,C2093656,C0003811,C0085612,C0189598,C0543467
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. C0004268,C0019993,C0030705,C0205191,C0205555,C0237543,C0449913,C1704419,C0309872
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) C0001072,C0002766,C0007222,C0007226,C0012634,C0030705,C0086388,C0150223,C0162791,C0175668,C0178916,C0205485,C0264656,C0441655,C0444868,C0455346,C0455404,C0455539,C0547043,C0557480,C0679699,C0680022,C0849932,C0871489,C1275743,C1519814,C1548787,C1704419,C2963144,C3714738,C3827828,C3887460,C4281991,C0007222,C0012634,C0199176,C0277555,C0589120,C0679699,C1275743
32651 Palliative and supportive care is effective for patients with symptomatic advanced Heart Failure to improve quality of life. (I-B) C0030705,C0184511,C0231220,C0332306,C0344211,C0376558,C1285530,C1704419,C0030231,C0344211,C0518214
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. C0030705,C0034975,C0079809,C0162791,C0205210,C0332306,C0597198,C0679823,C2986411,C3484370,C2728259
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 C0205281,C0392762,C0870078,C2986496,C2986822,C0441621,C2242979
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 C0003232,C0030705,C0205281,C0348026,C0392762,C0449864,C0558229,C0870078,C0871685,C0884358,C1294291,C1947903,C1997218,C2986496,C2986822,C3266812,C3845935,C3845943,C4075947,C4330848,C0003232,C0441621,C2242979
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 C0030705,C0521346,C0884358,C1301820,C1882120,C1997218,C0444279
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 C0003232,C0030705,C0205210,C0229671,C0243161,C0338237,C1997218,C0003232,C0087111,C0162566,C0229671,C0338237
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 C0003232,C0006279,C0030705,C0205210,C0243161,C0338237,C1535502,C1997218,C0003232,C0006279,C0022100,C0087111,C0338237,C1535502
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 C0003232,C0030705,C0205210,C0243161,C0338237,C1997218,C0003232,C0006560,C0087111,C0338237
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 C0003232,C0030705,C0205210,C0243161,C0338237,C1997218,C0003232,C0087111,C0338237
32661 In patients with VAT, we suggest not providing antibiotic therapy C0003232,C0030705,C0338237,C0003232,C0087111,C0338237
32662 In patients with suspected VAP, we recommend including coverage for S. aureus, Pseudomonas aeruginosa, and other gram-negative bacilli in all empiric regimens C0030705,C0033808,C0033809,C0205160,C0205394,C0308738,C0439208,C0444868,C1880496,C1997218,C3266626,C0449210
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 C0025643,C0030705,C0035647,C0035648,C0205177,C0205309,C0332282,C0439148,C0450442,C0521124,C0746919,C1512456,C1518029,C1521761,C1550281,C1552551,C1880496,C1997218,C3842589,C3842590,C4281815,C0450442
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). C0025643,C0030705,C0034866,C0035647,C0205177,C0205251,C0332288,C0332306,C0442811,C0442824,C0450442,C0455939,C0521124,C0746919,C1550281,C1762617,C1880496,C1997218,C3842589,C3842590,C3887511,C4281815,C0442811,C0450442
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. C0007546,C0020933,C0027324,C0029983,C0031955,C0034866,C0055003,C0066005,C0075870,C0205251,C0205447,C0282386,C0308738,C0332306,C0442811,C0442824,C0746919,C1444656,C1550281,C1762617,C1879523,C1880496,C3887511,C0007546,C0020933,C0027324,C0029983,C0031955,C0055003,C0066005,C0075870,C0282386,C0450442
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 C0007546,C0027324,C0029983,C0205447,C0746919,C1880496,C0007546,C0027324,C0029983,C0450442
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 C0003232,C0030705,C0035647,C0035648,C0183715,C0205160,C0205276,C0332282,C0427965,C0439148,C0439208,C0450442,C0746919,C0750591,C1521761,C1547045,C1552551,C1705242,C1880496,C1997218,C2936305,C3266626,C3842590,C4281815,C0003232,C0427965,C0450442
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 C0003232,C0030705,C0035647,C0205160,C0205177,C0205447,C0332288,C0439208,C0450442,C0455939,C0521124,C0746919,C0750591,C1880496,C1997218,C2936305,C3266626,C3842590,C4281815,C0003232,C0450442
32670 In patients with suspected VAP, we suggest avoiding aminoglycosides if alternative agents with adequate gram-negative activity are available C0002556,C0030705,C0205160,C0205411,C0439208,C1523987,C1997218,C3266626,C3845261,C0002556,C0450442
32671 In patients with suspected VAP, we suggest avoiding colistin if alternative agents with adequate gram-negative activity are available C0009316,C0030705,C0205160,C0205411,C0439208,C1523987,C1997218,C3266626,C3845261,C0009316,C0450442
32672 For patients being treated empirically for HAP, we recommend prescribing an antibiotic with activity against S. aureus C0003232,C0030705,C0521124,C2936305,C3845261,C0003232
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 C0003232,C0019993,C0025643,C0030705,C0035647,C0035648,C0205250,C0205309,C0332167,C0332285,C0348016,C0439083,C0439087,C0439148,C0521124,C0559680,C1512456,C1518029,C1521761,C1550281,C2936305,C3714514,C3842582,C3842589,C3844638,C3845261,C4319571,C0003232,C0343401
32674 For patients with HAP who require empiric coverage for MRSA, we recommend vancomycin or linezolid rather than an alternative antibiotic C0003232,C0030705,C0042313,C0308738,C0663241,C1523987,C1550281,C1880496,C0003232,C0042313,C0663241
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 C0003232,C0007546,C0020933,C0027324,C0029983,C0030705,C0031955,C0035647,C0055003,C0066005,C0075870,C0205250,C0205447,C0282386,C0308738,C0332167,C0455939,C0521124,C0746919,C1444656,C1550281,C1879523,C1880496,C2936305,C3714514,C3845261,C4319571,C0003232,C0007546,C0020933,C0027324,C0029983,C0031955,C0055003,C0066005,C0075870,C0282386,C0343401,C0450442
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 C0007546,C0020933,C0027324,C0029983,C0031955,C0055003,C0066005,C0075870,C0205447,C0282386,C0308738,C0746919,C1444656,C1550281,C1879523,C1880496,C0007546,C0020933,C0027324,C0029983,C0031955,C0055003,C0066005,C0075870,C0282386,C0450442
32677 For patients with HAP who are being treated empirically, we recommend prescribing antibiotics with activity against P. aeruginosa and other gram-negative bacilli C0003232,C0030705,C0205160,C0205394,C0439208,C0521124,C2936305,C3266626,C3845261,C0003232,C0449210
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 C0003232,C0030705,C0033808,C0035647,C0205160,C0205250,C0205394,C0332167,C0332285,C0348016,C0439083,C0439087,C0439208,C0442808,C0521124,C0559680,C1274351,C1705242,C1947903,C2936305,C3266626,C3714514,C3842582,C3845261,C4319571,C0003232,C0449210
32679 For patients with HAP who are being treated empirically, we recommend not using an aminoglycoside as the sole antipseudomonal agent C0002556,C0030705,C0450442,C3536835,C0450442
32680 For patients with HAP/VAP, we suggest that antibiotic dosing be determined using PK/PD data, rather than the manufacturer’s prescribing information C0003232,C0030705,C0521095,C0946213,C0947322,C1511726,C1533716,C1546888,C2936305,C0003232
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 C0002556,C0003232,C0009316,C0030705,C0032535,C0032538,C0032539,C0205160,C0205373,C0231204,C0439208,C0606677,C1706086,C3146286,C3266626,C0002556,C0003232,C0009316,C0032535,C0032539
32682 We recommend that MRSA HAP/VAP be treated with either vancomycin or linezolid rather than other antibiotics or antibiotic combinations C0003232,C0042313,C0205394,C0663241,C1550281,C3844638,C0003232,C0042313,C0356164,C0449210,C0663241
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 C0003232,C0030705,C0039593,C0183715,C0427965,C0443196,C0725610,C1547045,C1880496,C3146286,C0003232,C0087111,C0201179,C0427965
32684 For patients with HAP/VAP due to P. aeruginosa, we recommend against aminoglycoside monotherapy (strong recommendation, very low-quality evidence). C0002556,C0030705,C0034866,C0205251,C0332306,C0442811,C0442821,C0442824,C0521124,C3146286,C3536835,C3887511,C0442811
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 C0003232,C0030705,C0035647,C0036974,C0036983,C0039593,C0052142,C0054603,C0183715,C0205250,C0205309,C0231204,C0332167,C0333534,C0584697,C0584698,C0584699,C0584702,C0584703,C0584704,C0584705,C0584706,C0584708,C0584709,C0584710,C0584711,C1547045,C3146286,C4319571,C0003232,C0036974,C0036983,C0087111,C0427965,C0556895,C1306577
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 C0003232,C0030705,C0035647,C0036974,C0036983,C0039593,C0052142,C0054603,C0183715,C0205250,C0205309,C0231204,C0332167,C0333534,C0584697,C0584698,C0584699,C0584702,C0584703,C0584704,C0584705,C0584706,C0584708,C0584709,C0584710,C0584711,C1547045,C3146286,C4319571,C0003232,C0036974,C0036983,C0087111,C0427965,C0556895,C1306577
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 C0003232,C0030705,C0039593,C0183715,C0427965,C0443196,C0725610,C1444096,C1547045,C1880496,C3146286,C0003232,C0087111,C0427965
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 C0001138,C0002680,C0006968,C0030705,C0038665,C0231204,C0746919,C1264774,C1705920,C2930041,C3844638,C0002680,C0006968,C0038665,C0450442
32690 In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we recommend intravenous polymyxin (colistin or polymyxin B) C0001138,C0009316,C0030705,C0032535,C0032538,C0032539,C0332324,C0348016,C0606677,C1264774,C1705920,C0009316,C0032539
32691 In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin C0001138,C0009316,C0030705,C0032539,C0332324,C1264774,C1292783,C1705920,C0009316,C0032539
32692 In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin C0001138,C0009316,C0030705,C0035608,C0058534,C0332324,C1264774,C1292783,C1705920,C0009316,C0035608
32693 In patients with HAP/VAP caused by Acinetobacter species, we recommend against the use of tigecycline C0001138,C0030705,C0521124,C1260298,C1264774,C1705920,C1260298
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) C0006968,C0009316,C0030705,C0032535,C0032538,C0032539,C0332324,C0348016,C0606677,C3656682,C0006968,C0009316,C0032539
32695 In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin C0006968,C0009316,C0030705,C0032539,C0332324,C1292783,C3656682,C0006968,C0009316,C0032539
32696 For patients with VAP, we recommend a 7-day course of antimicrobial therapy rather than a longer duration C0030705,C0439228,C0750729,C2926735,C0087111,C2926735
32697 For patients with HAP, we recommend a 7-day course of antimicrobial therapy C0030705,C0439228,C0750729,C0087111
32698 For patients with HAP/VAP, we suggest that antibiotic therapy be de-escalated rather than fixed C0003232,C0030705,C0338237,C0003232,C0087111,C0338237
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 C0003232,C0030705,C0205210,C0243161,C0338237,C0003232,C0087111,C0162566,C0338237,C0457454,C2946261
32700 For patients with suspected HAP/VAP, we suggest not using the CPIS to guide the discontinuation of antibiotic therapy C0003232,C0030705,C0338237,C1997218,C0003232,C0087111,C0338237,C0457454
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 C0013568,C0015388,C0021099,C0034161,C0038128,C0038170,C0038172,C0038402,C0061856,C0221198,C0318153,C0318154,C0318155,C0439208,C0579243,C0579244,C1123023,C1532385,C1541907,C1820977,C3846195,C3846199,C0013568,C0015388,C0021099,C0034161,C0037284,C0038128,C0061856,C0200966,C0221198,C1123023,C1278993,C2242979
32702 Treatment without gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma is reasonable in typical cases C0013568,C0015388,C0021099,C0034161,C0038128,C0061856,C0221198,C0332288,C0439208,C0746919,C1123023,C0013568,C0015388,C0021099,C0034161,C0037284,C0038128,C0061856,C0200966,C0221198,C1123023,C1278993,C2242979
32703 Treatment of bullous and nonbullous impetigo should be with either mupirocin or retapamulin bid for 5 days C0021099,C0085259,C0205405,C0406096,C0746919,C1703334,C3844638,C0021099,C0021100,C0085259,C1703334
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) C0013568,C0021099,C0030842,C0038402,C0205177,C0220892,C0439228,C0442027,C0450442,C0521124,C1820977,C1879523,C3846195,C3846199,C0013568,C0021099,C0030842,C0087111,C0220892,C0450442,C2242979
32705 Because Staphylococcus aureus isolates from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or cephalexin is recommended. C0007716,C0012093,C0013568,C0021099,C0025643,C0038170,C0038172,C0231204,C1820977,C3846195,C3846199,C3888388,C0007716,C0012093,C0013568,C0021099,C0025643
32706 When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended C0008947,C0013090,C0025643,C0038170,C0038172,C0038689,C0041041,C0343401,C0521093,C0729578,C1142536,C1265292,C1294237,C1303247,C1319191,C1319192,C1507063,C1820977,C1997218,C2317549,C2586075,C2586183,C2732959,C2733047,C3164390,C3846195,C3846199,C4038893,C4040100,C4040349,C4047724,C4303145,C4510407,C0008947,C0013090,C0025643,C0038689,C0041041,C0343401
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 C0009462,C0017658,C0038402,C0038411,C0205373,C0347984,C0403414,C0687676,C3714514,C0017658,C0080194,C0403414
32708 Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases C0000833,C0007078,C0034161,C0038128,C0061856,C0332288,C0439208,C0746919,C1820977,C3846195,C3846199,C0000833,C0007078,C0034161,C0038128,C0061856,C0200966,C2242979
32709 Gram stain and culture of pus from inflamed epidermoid cysts are NOT recommended C0010709,C0034161,C0038128,C0061856,C0439208,C1820977,C3846195,C3846199,C0010709,C0014511,C0034161,C0038128,C0061856,C0200966,C2242979
32710 Incision and drainage is the recommended treatment for inflamed epidermoid cysts, carbuncles, abscesses and large furuncles C0000833,C0007078,C0010709,C0152277,C0181296,C0242301,C0549177,C0746919,C1820977,C3846195,C3846199,C0000833,C0007078,C0010709,C0012621,C0013103,C0014511,C0152277,C0184898,C0242301
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 C0003232,C0005767,C0005771,C0005773,C0005903,C0007584,C0007634,C0039082,C0039231,C0039476,C0152277,C0181296,C0205373,C0225386,C0231835,C0242966,C0333348,C0438221,C0439083,C0439087,C0521124,C0580531,C0679006,C0750480,C1292504,C1300557,C1879741,C1960440,C3241939,C3842327,C3842582,C4282382,C4319606,C0003232,C0005767,C0005771,C0005773,C0007584,C0007634,C0012621,C0013103,C0023508,C0023516,C0039082,C0039231,C0184898,C0225386,C0231835,C0242966,C0392148,C1269647,C1689985
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 C0000833,C0003232,C0007078,C0020649,C0030705,C0205177,C0205265,C0221099,C0231175,C0521124,C0746919,C1550281,C1820977,C3846195,C3846199,C0000833,C0003232,C0007078,C0020649
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 C0000833,C0010709,C0031925,C0085160,C0162836,C0205145,C0205156,C0205276,C0445615,C0449760,C0520510,C1517294,C1550293,C1602245,C2945760,C3714514,C0000833,C0010709,C0016542,C0031925,C0085160,C0162836
32714 Recurrent abscesses should be drained and cultured early in the course of infection C0000833,C0750729,C1279919,C2945760,C3714514,C0000833
32715 After obtaining cultures of recurrent abscess, treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated C0000833,C0003232,C0205177,C0205409,C0439228,C0521124,C0750729,C2945760,C3842590,C0000833,C0003232,C2242979
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 ( C0008196,C0011121,C0085259,C0332173,C0336616,C0439228,C0750591,C1879523,C2718306,C2945760,C3714514,C4520447,C0008196,C0011121,C0085259
32717 Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood C0000833,C0001675,C0027950,C0030705,C0231335,C0599196,C1279919,C2945760,C0000833,C0012634,C0027950
32718 Cultures of blood or cutaneous aspirates, biopsies, or swabs are NOT routinely recommended C0005767,C0221912,C1261188,C1820977,C3846195,C3846199,C0005767,C0370199,C1261188,C2242979
32719 Cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites C0003062,C0003794,C0005767,C0007634,C0015408,C0027947,C0030705,C0086597,C0392207,C1820977,C1855166,C3665472,C3714592,C3842363,C3846195,C3846199,C0003044,C0005658,C0005767,C0007634,C0013216,C0021051,C0027947,C0038561,C0392920,C1269647,C1302713,C1306459,C2242979
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 ( C0003062,C0003794,C0007634,C0015408,C0027947,C0030705,C0086597,C0205288,C0221912,C0392207,C0750591,C1261188,C1855166,C3665472,C3714592,C3842363,C4321457,C0003044,C0005658,C0007634,C0013216,C0021051,C0026018,C0027947,C0031809,C0038561,C0370199,C0392920,C1261188,C1269647,C1302713,C1306459,C2242979
32721 Typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci C0007642,C0038402,C0205177,C0205373,C0332288,C0450442,C0521124,C1514756,C3714514,C0007642,C0243026,C0311392,C0450442
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) ( C0003232,C0007642,C0025643,C0205373,C0231204,C0308738,C0521124,C0871685,C1444656,C1947903,C3714514,C0003232,C0007642,C0025643,C0243026,C0311392
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 C0007642,C0030705,C0038402,C0042313,C0332281,C0521124,C1272883,C1550281,C1704419,C1706086,C1820977,C3639310,C3714514,C3714660,C3846195,C3846199,C3887511,C4289767,C0007642,C0013227,C0028429,C0042313,C0043251,C0343401,C1272883,C1533685,C3263723
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 C0003232,C0005758,C0005767,C0005771,C0005773,C0005903,C0007584,C0007634,C0018787,C0018810,C0020649,C0030705,C0039231,C0039476,C0085393,C0152009,C0178784,C0205161,C0205210,C0205373,C0225386,C0231175,C0231832,C0231835,C0308738,C0349410,C0437769,C0438221,C0439083,C0439087,C0439385,C0439386,C0442027,C0521346,C0580531,C0587785,C0702093,C0746919,C0750480,C0750591,C0877198,C1123023,C1292504,C1521828,C2827424,C3241939,C3714514,C3816746,C3842582,C3887504,C3887511,C0003232,C0005758,C0005767,C0005771,C0005773,C0007584,C0007634,C0018787,C0020649,C0023508,C0023516,C0027544,C0039231,C0152009,C0225386,C0231835,C0243026,C0275521,C0311392,C0333717,C0333794,C0449201,C1123023,C1269647,C1278993,C1281570,C1294063
32725 Vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as a reasonable empiric regimen for severe infections C0020933,C0031955,C0042313,C0066005,C0075870,C1820977,C1879523,C1880496,C3714514,C3844638,C3846195,C3846199,C0020933,C0031955,C0042313,C0066005,C0075870
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 C0040223,C0184511,C0231449,C0332285,C0746919,C1820977,C2926735,C3714514,C3846195,C3846199,C0087111,C2926735
32727 Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended C0013604,C0205146,C0221912,C0349738,C0702240,C0746919,C1820977,C3846195,C3846199,C0012634,C0013604,C0439775
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 C0007642,C0021149,C0023216,C0239998,C0333525,C0442105,C0871685,C1522326,C1837066,C1853193,C1947916,C2945760,C3714514,C4289767,C0007642,C0015385,C0023216,C0040357,C0237849,C0278456,C0333525,C1281539,C1281589
32729 Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability C0019010,C0029921,C0030705,C0278060,C0449438,C0919772,C0948268,C1444783,C1820977,C3846195,C3846199,C0087111,C0278060,C0948268,C1444783
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 C0019993,C0029921,C0030705,C0085393,C0439664,C0587785,C0746919,C1820977,C2699424,C3714514,C3846195,C3846199,C0087111
32731 Systemic corticosteroids (eg, prednisone 40 mg daily for 7 days) could be considered in nondiabetic adult patients with cellulitis C0001675,C0007642,C0030705,C0032952,C0205373,C0239126,C0332173,C0352680,C0439509,C0750591,C3842587,C4321396,C0001617,C0007642,C0032952,C1382730
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. C0007642,C0013595,C0013604,C0015393,C0028754,C0030705,C0042485,C0205178,C0205547,C0231179,C0347984,C0348013,C0449719,C0884358,C1306673,C3809765,C0007642,C0013595,C0013604,C0028754,C0040357,C0230506,C0332875,C1281589
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 C0001555,C0001557,C0003232,C0007642,C0014806,C0030705,C0030829,C0030842,C0053153,C0220892,C0404392,C0439230,C0439234,C0439508,C0442027,C0442117,C0442757,C0750591,C1442457,C1442462,C1442465,C2348003,C3843352,C0003232,C0007642,C0014806,C0030829,C0030842,C0199779,C0220892,C0308718,C0360341,C1533734
32734 This program should be continued so long as the predisposing factors persist C0205166,C2728259,C3499620,C2728259
32735 Suture removal plus incision and drainage should be performed for surgical site infections C0152277,C0181296,C0183720,C0184936,C0205145,C0884358,C3714514,C0012621,C0013103,C0015252,C0038969,C0184898,C0543467
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 C0005903,C0018787,C0018810,C0039476,C0041834,C0152277,C0181296,C0205145,C0205373,C0332281,C0332534,C0750480,C0750502,C1292783,C1300557,C1444656,C1521828,C1545981,C2699427,C3714514,C4282382,C4517536,C0012621,C0013103,C0018787,C0023508,C0041834,C0043250,C0087111,C0184898,C0332534,C0543467,C1281570
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 C0018670,C0027530,C0030705,C0205145,C0205373,C0278454,C0750729,C1444656,C1879313,C3714514,C0018670,C0027530,C0087111,C0185774,C0243026,C0311392,C0460004,C0460005,C0543467,C1280632,C1281590,C1281592,C1283900
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 C0003232,C0019993,C0030842,C0035647,C0038167,C0042313,C0055075,C0057144,C0079411,C0205250,C0220892,C0304317,C0304319,C0304320,C0314650,C0314651,C0332185,C0361823,C0392343,C0455939,C0663241,C1453642,C1550281,C1820977,C2001521,C3536856,C3714514,C3846195,C3846199,C4289767,C0003232,C0028429,C0030842,C0042313,C0057144,C0220892,C0304317,C0343401,C0663241,C1453642,C2001521,C2266959
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 C0004454,C0004611,C0017420,C0017421,C0025872,C0052142,C0054603,C0055075,C0086287,C0205160,C0205177,C0227749,C0262498,C0439208,C0444206,C0521124,C0521362,C0567314,C0762875,C0949665,C1185740,C1443304,C1636650,C1820977,C3266626,C3536856,C3714514,C3846195,C3846199,C0004454,C0017421,C0025872,C0031066,C0450442,C0543467,C0559522,C0700038,C1279154,C1280088,C1283835,C1284953,C2266959
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 C0009818,C0015645,C0017086,C0017105,C0030705,C0205373,C0238124,C0242114,C0332281,C0439664,C1602245,C1820977,C3714514,C3846195,C3846199,C0009818,C0015645,C0017086,C0017105,C0017110,C0238124,C0311392,C0543467,C0600688,C1602245,C1704673
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) C0003232,C0006968,C0007561,C0009462,C0025872,C0031955,C0038402,C0042313,C0075870,C0318158,C0318160,C0318161,C0318162,C0318163,C0318164,C0318165,C0318166,C0318167,C0318168,C0318169,C0318170,C0318171,C0318172,C0318173,C0441833,C0456394,C0663241,C0746919,C1314792,C1510824,C1550281,C1711239,C1880496,C3641081,C0003232,C0006968,C0007561,C0025872,C0031955,C0042313,C0075870,C0663241
32742 Penicillin plus clindamycin is recommended for treatment of documented Group A streptococcal necrotizing fasciitis C0008947,C0015645,C0030842,C0038402,C0220892,C0238124,C0439664,C0441833,C0746919,C0854084,C1301725,C1820977,C3846195,C3846199,C0008947,C0015645,C0030842,C0220892,C0238124,C0854084
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. C0011900,C0024485,C0040395,C0040405,C0412588,C0412604,C0695347,C1275506,C1285464,C1704275,C1820977,C2364239,C3827682,C3846195,C3846199,C0011900,C0011923,C0024485,C0040395,C0040405,C0041618,C0231881,C1704275
32744 Cultures of blood and abscess material should be obtained C0000833,C0005767,C0520510,C1301820,C1882120,C0000833,C0005767,C2242979
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). C0030705,C0042313,C0085393,C0175566,C0205160,C0205177,C0205265,C0439208,C0450442,C0521124,C0587785,C1820977,C1880496,C3266626,C3714514,C3714660,C3846195,C3846199,C0026845,C0042313,C0043251,C0087111,C0450442,C3263723
32746 Cefazolin or antistaphylococcal penicillin (eg, nafcillin or oxacillin) is recommended for treatment of pyomyositis caused by MSSA (SR-M). C0007546,C0027324,C0029983,C0030842,C0220892,C0746919,C1704275,C1820977,C3846195,C3846199,C0007546,C0027324,C0029983,C0030842,C0220892,C1704275
32747 Early drainage of purulent material should be performed C0439665,C0520510,C0884358,C1279919,C0012621,C0013103
32748 Repeat imaging studies should be performed in patients with persistent bacteremia to identify undrained foci of infection C0004610,C0030705,C0205322,C0205341,C0884358,C3714514,C4321394,C0004610,C0011923
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. C0000833,C0003232,C0004610,C0014118,C0030705,C0036525,C0184511,C0205265,C0205448,C0205449,C0332125,C0439230,C0442027,C0521097,C1442457,C1442462,C1442465,C1548562,C1548787,C1820977,C3846195,C3846199,C3887511,C4082109,C0000833,C0003232,C0004610,C0014118,C0087111
32750 Urgent surgical exploration of the suspected gas gangrene site and surgical debridement of involved tissue should be performed C0011079,C0017086,C0017105,C0205145,C0439609,C0455097,C0884358,C1997218,C4296884,C0011079,C0017086,C0017105,C0017110,C0040300,C0184899,C0543467,C1280903,C1704673
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). C0002680,C0006968,C0011900,C0031955,C0038665,C0042313,C0075870,C0443196,C0746919,C1820977,C2827424,C2930041,C3844638,C3846195,C3846199,C0002680,C0006968,C0011900,C0031955,C0038665,C0042313,C0075870,C1689985
32752 Definitive antimicrobial therapy with penicillin and clindamycin is recommended for treatment of clostridial myonecrosis (SR-L). C0008947,C0030842,C0220892,C0443196,C0746919,C1820977,C3846195,C3846199,C0008947,C0017105,C0030842,C0087111,C0220892
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). C0011079,C0020431,C0030054,C0030705,C0150238,C0184633,C0455097,C0814225,C1293855,C1820977,C1960973,C3846195,C3846199,C0011079,C0020431,C0030054,C0035273,C0087111,C0184633,C0543467
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). C0003794,C0012634,C0013604,C0015408,C0015450,C0018563,C0022417,C0023884,C0023895,C0030705,C0031110,C0085393,C0205146,C0348754,C0442758,C0455417,C0455550,C0587785,C1279919,C1299393,C1820977,C2347662,C3846195,C3846199,C0006935,C0012634,C0013604,C0015450,C0018563,C0022417,C0023884,C0023895,C0031110,C0087111,C1269611,C1278929,C1281583,C1281591
32755 Postexposure prophylaxis for rabies may be indicated. Consultation with local health officials is recommended to determine if vaccination should be initiated (SR-L). C0009818,C0018684,C0042196,C0182428,C0205276,C0521095,C1320204,C1444656,C1820977,C3846195,C3846199,C0009818,C0034494,C0042196,C0199176
32756 An antimicrobial agent or agents active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate should be used C0002645,C0004611,C0004613,C0054066,C0110038,C0205177,C0450442,C0521124,C1510824,C1532934,C1706086,C3641081,C0002645,C0110038,C0450442
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). C0030705,C0039614,C0040555,C0042196,C0332285,C0332288,C0439234,C0750523,C1270260,C1442162,C1548562,C2114533,C3842590,C3843647,C0039614,C0039620,C0040555,C0042196,C0305060,C0305062
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. C0003232,C0011079,C0015450,C0022100,C0205225,C1521802,C1547545,C1820977,C3845930,C3846195,C3846199,C0003232,C0011079,C0015450,C0022100,C0043250,C0185003,C0439631,C0441503,C1281591
32759 Other wounds may be approximated (WR-L). C0205394,C0332232,C0043250,C0449210
32760 Oral penicillin V 500 mg qid for 7-10 days is the recommended treatment for naturally acquired cutaneous anthrax (SR-H). C0003177,C0030842,C0220892,C0221912,C0442027,C0746919,C1820977,C3816747,C3842590,C3846195,C3846199,C4321396,C0003175,C0003177,C0030840,C0030842,C0220892,C1125626
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. C0001712,C0008809,C0101745,C0282386,C0332157,C0872021,C1820977,C3816747,C3842585,C3846195,C3846199,C4321396,C0008809,C0150009,C0150032,C0150061,C0150082,C0231357,C0231359,C0231379,C0231393,C0231416,C0231418,C0274281,C0282386,C0582147,C0582456,C0992502,C1112870,C1123173
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 C0007361,C0012634,C0030705,C0052796,C0205172,C0238909,C0301453,C0332283,C0439228,C0439400,C0439418,C1524062,C1532536,C1820977,C3665414,C3816747,C3842590,C3846195,C3846199,C4321396,C0007361,C0012634,C0052796,C0238909,C1384489
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). C0002992,C0013090,C0014806,C0085434,C0439230,C0439231,C0746919,C1442456,C1442457,C1442461,C1442462,C1442465,C1820977,C3816747,C3817553,C3843385,C3846195,C3846199,C4321396,C0002992,C0013090,C0014806,C0085434,C1123142,C1374596
32764 Penicillin 500 mg qid or amoxicillin 500 mg tid for 7-10 days is recommended for treatment of erysipeloid (SR-H). C0002645,C0030842,C0220892,C0746919,C1820977,C3816747,C3842590,C3846195,C3846199,C4321396,C0002645,C0014736,C0030842,C0220892,C0993263,C1276801
32765 Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L). C0007559,C0008809,C0013090,C0020933,C0183715,C1547045,C1820977,C3846195,C3846199,C3854019,C0007559,C0008809,C0013090,C0017436,C0020933
32766 Bubonic plague should be diagnosed by Gram stain and culture of aspirated material from a suppurative lymph node C0024202,C0024204,C0032064,C0038128,C0061856,C0282312,C0439208,C0520510,C0024202,C0024204,C0032064,C0038128,C0061856,C0200966,C0282312,C1269047,C2242979,C3249881
32767 Streptomycin 15 mg/kg IM q12h or doxycycline 100 mg bid PO is recommended for treatment of bubonic plague (SR-L). C0013090,C0032064,C0038425,C0282312,C0746919,C1820977,C3817553,C3846195,C3846199,C4321396,C0013090,C0032064,C0038425,C0150009,C0150032,C0150061,C0150082,C0231357,C0231359,C0231377,C0231379,C0231393,C0231416,C0231418,C0282312,C0582147,C0582456,C1123142
32769 Serologic tests are the preferred method of diagnosing tularemia (WR-L). C0011900,C0025663,C0041351,C0205473,C0036743,C0041351
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). C0038425,C0041351,C0746919,C1820977,C3846195,C3846199,C3854019,C4321396,C0017436,C0038425,C0041351,C0231377
32771 Tetracycline 500 mg qid or doxycycline 100 mg bid PO is recommended for treatment of mild cases of tularemia (SR-L). C0013090,C0039644,C0041351,C0746919,C1820977,C3816747,C3817553,C3846195,C3846199,C4321396,C0013090,C0039644,C0041351,C0150009,C0150032,C0150061,C0150082,C0231357,C0231359,C0231379,C0231393,C0231416,C0231418,C0582147,C0582456,C1123142,C1123624
32772 Notify the microbiology laboratory if tularemia is suspected (SR-H). C0001867,C0016477,C0022877,C0037593,C0041351,C1997218,C0041351,C0085672
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). C0011609,C0011900,C0011906,C0012634,C0014742,C0039082,C0041834,C0042384,C0085077,C0151436,C0221198,C0221242,C0221912,C0302295,C0332448,C0442740,C0851346,C1123023,C1515895,C1705242,C3665472,C3714514,C3841811,C3842363,C0011609,C0011900,C0011906,C0012634,C0013216,C0013227,C0014742,C0015230,C0037284,C0039082,C0040732,C0041834,C0042384,C0151436,C0221198,C0302295,C0332448,C0332835,C0392920,C0702249,C1123023,C1278993,C1306459,C2973529
32774 Differential diagnosis for infection of skin lesions should include bacterial, fungal, viral and parasitic agents (SR-H). C0011900,C0011906,C0221198,C0521009,C0521026,C0521033,C0521066,C1123023,C1705242,C3714514,C0011900,C0011906,C0037278,C0037284,C0221198,C0304207,C0450442,C1123023,C1268919,C1278993
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). C0005558,C0205462,C0220825,C0221198,C0348026,C0520510,C1279919,C1301820,C4520547,C0005558,C0220787,C0221198,C0349707,C0700198,C1261322
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) C0015967,C0027947,C0030705,C0205265,C0205322,C0332189,C0449450,C0521095,C2945760,C3842885,C4288071,C0015967,C0027947
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 C0005558,C0149778,C0205358,C0205462,C0205471,C0221198,C0225317,C0263955,C0521095,C1123023,C1314792,C3714514,C0005558,C0037278,C0038128,C0040300,C0149778,C0150866,C0200965,C0220787,C0221198,C0225317,C0349707,C0410013,C0684084,C0700198,C1123023,C1261322,C1278993,C1298701,C2242979
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 C0007634,C0009488,C0015967,C0027947,C0030705,C0035647,C0183715,C0205250,C0205251,C0205388,C0332167,C0344211,C0439590,C0439808,C0449820,C1547045,C1879313,C3538919,C3714514,C3817553,C3840775,C3843331,C4319571,C0007634,C0015967,C0027947,C0344211,C1269647
32779 Determine the extent of infection through a thorough physical examination, blood cultures, chest radiograph and additional imaging (including chest CT) C0005767,C0031809,C0202823,C0205485,C0263955,C0332273,C0439792,C0521095,C0817096,C1524062,C3714514,C4321457,C0005767,C0011923,C0031809,C0200949,C0202823,C0817096,C1306645,C2242979
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 C0003232,C0006968,C0008777,C0019993,C0020933,C0042313,C0055003,C0066005,C0071972,C0389169,C1820977,C1880496,C3846195,C3846199,C0003232,C0006968,C0008777,C0020933,C0042313,C0055003,C0066005,C0087111,C0279516,C0389169
32781 Documented clinical and microbiologic skin and soft tissue infections should be treated based on antimicrobial susceptibilities of isolated organisms C0029235,C0205210,C0205358,C0205409,C0225317,C1123023,C1301725,C3714514,C0037278,C0040300,C0149778,C0225317,C0684084,C1123023,C1278993
32782 The treatment duration for most bacterial skin and soft tissue infections should be 7-14 days C0205358,C0205393,C0225317,C0444921,C0521009,C0746919,C1123023,C2926735,C3714514,C0004623,C0037278,C0040300,C0149778,C0225317,C0684084,C1123023,C1278993,C2926735
32783 Surgical intervention is recommended for drainage of soft-tissue abscess after marrow recovery or for a progressive polymicrobial necrotizing fasciitis or myonecrosis C0000833,C0015645,C0205329,C0205358,C0225317,C0238124,C0376152,C0439664,C0444063,C1820977,C3846195,C3846199,C4302231,C0000833,C0012621,C0013103,C0015645,C0040300,C0225317,C0344096,C0543467,C1273869
32784 Adjunct colony-stimulating factor therapy (G-CSF, GM-CSF) or granulocyte transfusions C0009392,C0018183,C0079784,C0314599,C1521761,C0018183,C0087111,C1879316
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). C0001367,C0030705,C0042776,C0205221,C0221912,C0276224,C0276248,C0370133,C0443710,C0450101,C0521093,C0586989,C1304000,C1304015,C1548562,C1997218,C3714514,C4511149,C4511150,C4511151,C4511152,C4511153,C0001367,C0008049,C0019348,C0019360
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). C0015967,C0027947,C0043393,C0205225,C0272313,C0332281,C0678026,C1879523,C1880496,C3714514,C0003308,C0015967,C0027947,C0087111,C0279516,C0439631
32787 Empiric administration of vancomycin or other agents with Gram-positive activity (linezolid, daptomycin or ceftaroline) should be added if not already being administered C0001555,C0001557,C0018155,C0042313,C0057144,C0205394,C0439208,C0663241,C1446409,C1548562,C1880496,C2001521,C2348003,C3845261,C0042313,C0057144,C0449210,C0450442,C0663241,C1533734,C2001521
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) C0023767,C0023779,C0058920,C0085795,C0205358,C0205409,C0225317,C0319878,C0486500,C0720512,C0908707,C1123023,C1268551,C1705920,C3482104,C3712748,C3714514,C3873288,C4508237,C0002679,C0006840,C0023779,C0037278,C0040300,C0085795,C0149778,C0225317,C0684084,C1123023,C1268551,C1278993
32789 if Candida parapsilosis has been isolated treat with fluconazole as an acceptable alternative to lipid formulation amphotericin-B C0016277,C0023767,C0023779,C0085795,C0205409,C0319878,C0720512,C0908707,C1523987,C1879533,C3482104,C0002679,C0016277,C0023779,C0085795
32790 Treatment should be for 2 weeks after clearance of blood stream infection or resolution of skin lesions. C0005767,C0221198,C0439230,C0442540,C0449297,C0746919,C1123023,C1442457,C1442462,C1442465,C2699488,C3714514,C0005767,C0037284,C0221198,C1123023,C1278993
32791 Aspergillus skin and soft tissue infections should be treated with voriconazole C0004034,C0205358,C0225317,C0393080,C1123023,C3714514,C0037278,C0040300,C0149778,C0225317,C0393080,C0684084,C1123023,C1278993
32792 alternatively to voriconazole treat Aspergillus skin and soft tissue infections with lipid formulations of amphotericin B, posaconazole or echinocandin for 6-12 weeks C0004034,C0023767,C0023779,C0058920,C0085795,C0205358,C0225317,C0393080,C0439230,C0936148,C1123023,C1268551,C1442457,C1442462,C1442465,C3712748,C3714514,C4508237,C0002679,C0023779,C0037278,C0040300,C0085795,C0149778,C0225317,C0393080,C0684084,C0936148,C1123023,C1268551,C1278993
32793 Mucor/Rhizopus infections should be treated with lipid formulation amphotericin B C0023767,C0023779,C0026716,C0035477,C0085795,C0720512,C0908707,C3714514,C0002679,C0023779,C0085795
32794 Mucor/Rhizopus infections should be treated with posaconazole C0026716,C0035477,C0936148,C3714514,C0936148
32795 The addition of an echinocandin could be considered based on synergy in murine models of mucormycosis and observational clinical data (WR-L). C0026718,C0058920,C0205210,C0591833,C0750591,C1268551,C1511726,C1518527,C3161035,C3712748,C4288563,C4508237,C0026718,C1268551
32796 Fusarium species infections should be treated with high-dose IV voriconazole or posaconazole C0016871,C0205250,C0393080,C0444956,C0936148,C1705920,C3714514,C0276758,C0393080,C0936148
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). C0001367,C0030705,C0205221,C0221912,C0348016,C0521093,C1304015,C1879523,C1997218,C3714514,C0001367
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 C0005558,C0005767,C0030705,C0043393,C0221198,C0565118,C0728940,C1123023,C1298665,C1301820,C1711239,C1882120,C0005558,C0005767,C0037284,C0200949,C0220787,C0221198,C0349707,C0543467,C0700198,C0728940,C1123023,C1278993,C2242979
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). C0005767,C0011900,C0030705,C0032520,C0205100,C0205221,C0221198,C0229664,C0443286,C1123023,C1335439,C2364239,C3714514,C3898897,C4288071,C0005767,C0011900,C0032520,C0037284,C0221198,C0229664,C1123023,C1278993
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) C0003241,C0009818,C0015411,C0021081,C0023418,C0023434,C0023449,C0024264,C0024299,C0027540,C0029166,C0030705,C0037285,C0178539,C0178784,C0205253,C0221912,C0241888,C0259831,C0333516,C0439662,C0746619,C0750591,C0855095,C1280464,C1334804,C3696887,C3714514,C0009818,C0013227,C0023418,C0023448,C0024299,C0040732,C0301889,C0332835,C1533651
32802 Consider biopsy and surgical debridement early in the management of these patients C0002766,C0005558,C0011079,C0030705,C0455097,C0565118,C0750591,C1279919,C0005558,C0011079,C0543467
32804 The use of specific agents should be decided with the input of the primary team, dermatology, infectious disease and other consulting teams C0012634,C0151317,C0205225,C0205394,C0260050,C0275518,C0871489,C1708517,C0009450,C0012634,C0439631,C0449210,C0450442
32805 In patients with a suspected or known abdominal aortic aneurysm (AAA), the SVS recommends performing physical examination that includes an assessment of femoral and popliteal arteries. C0002940,C0003486,C0003842,C0030705,C0031809,C0162871,C0205309,C0205485,C0229026,C0265012,C0340632,C0425669,C0442037,C0553958,C0682001,C1268311,C1282539,C1960866,C1997218,C3698466,C4275172,C4321457,C0000726,C0002940,C0003483,C0003486,C0015811,C0031809,C0162871,C0442037,C1261322