| Document ID | Recommendation | cTakes CUI Set | Dice CUI Set |
|---|---|---|---|
| 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. | C0262926:"Medical History", C0018799:"Heart Diseases", C0031809:"Physical Examination", C0012634:"Disease" | C0263955:Thoroughpin, C0019664:History, C0205485:Physical, C4321457:Examination, C1301820:Obtain, C1882120:Not Obtained, C0884358:Performed, C0030705:Patients, C0426109:Caput presenting, C0004927:Behavior, C0521110:Accelerated, C1527148:Development, C0449258:Progression, C0031809:Physical Examination, C0150618:History and physical examination, C0199189:History and physical examination, complete, C0199190:History and physical examination, limited, C0199191:History and physical examination, diagnostic, C0199192:History and physical examination, monitoring, C0199198:History and physical examination, premarital, C0199202:History and physical examination, license, C0420111:History and physical examination, insurance, C0420160:History and physical examination, school, C0481846:History and physical examination, occupation, C0199193:History and physical examination, follow-up |
| 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. | C0262926:"Medical History", C0033141:"Cardiomyopathies, Primary", C0878544:"Cardiomyopathies", C0241889:"Family history", C0011900:"Diagnosis" | C0030705:Patients, C0700124:Dilated, C0878544:Cardiomyopathies, C1837350:No cardiomyopathy, C0007193:Cardiomyopathy, Dilated, C0007930:Chagas Cardiomyopathy, C0015576:Family, C0019664:History, C1301820:Obtain, C1882120:Not Obtained, C0443211:Established, C0150735:Establishing Rapport, C2364239:Establishing Trust, C0011900:Diagnosis, C0241888:Familial, C0264795:Secondary dilated cardiomyopathy, C0340427:Familial dilated cardiomyopathy, C3532251:Fetal dilated cardiomyopathy, C3668940:Dmd-Associated Dilated Cardiomyopathy, C0241889:Family history, C0420612:History not obtained, C1449563:Cardiomyopathy, Familial Idiopathic |
| 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. | C0460139:"Pressure (finding)", C1261322:"Evaluation procedure", C0428897:"Jugular venous pressure", C0013604:"Edema", C0085649:"Peripheral edema", C0311392:"Physical findings", C0392148:"Providing presence (regime/therapy)", C0085619:"Orthopnea" | C0449468:Volume, C0449438:Status, C1516048:Assessed, C0030705:Patients, C1947978:Encounter, C4065484:diet includes, C4554600:Serial, C0043100:Weight, C3146287:Well, C0750572:Estimated, C0348013:Venous, C1882095:No Pressure, C0001876:Air Pressure, C0150312:Present, C0205100:Peripheral, C0013604:Edema, C0085619:Orthopnea, C0422288:Letter encounter to patient, C0422305:Patient-initiated encounter, C0582950:Patient encounter status, C0586016:Patient encounter procedure, C1444339:Weight control assessment, C0232133:Jugular venous pulse, C0042486:Venous Blood Pressure, C0184275:Venous pressure monitor, C0232114:Abnormal venous pressure, C0428640:Central venous pressure, C0428897:Jugular venous pressure, C0429872:Venous mean pressure, C0520855:Venous wedge pressure, C0085649:Peripheral edema |
| 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. | C0040135:"Thyroid Hormones", C0041942:"Urea", C0019932:"Hormones", C0229671:"Serum", C0040132:"Thyroid Gland", C0042014:"Urinalysis", C0009555:"Complete Blood Count", C0024467:"Magnesium", C0007634:"Cells", C0005845:"Blood urea nitrogen measurement", C0023779:"Lipids", C0005767:"Blood", C1291218:"Carbonyldiamide", C1269647:"Entire cell", C0587355:"Electrolytes measurement, serum", C1261322:"Evaluation procedure", C0600137:"Blood Urea Nitrogen", C0013832:"Electrolytes", C0010294:"Creatinine", C0015663:"Fasting", C0007584:"Cell Count", C1278929:"Entire liver", C0006675:"Calcium", C0023884:"Liver", C0023901:"Liver Function Tests", C0005773:"Blood Cells", C0201976:"Creatinine measurement, serum (procedure)", C0005771:"Blood Cell Count", C0028158:"Nitrogen", C0430044:"Fasting lipid profile", C0040160:"Thyrotropin", C0017725:"Glucose" | C0205265:Initially, C0022877:Laboratory, C0220825:Evaluation, C0030705:Patients, C0426109:Caput presenting, C0205197:Complete, C0005767:Blood, C0007634:Cells, C0750480:Count, C0042014:Urinalysis, C0242485:Measurement, C0229671:Serum, C0013832:Electrolytes, C0006675:Calcium, C0024467:Magnesium, C0041942:Urea, C0028158:Nitrogen, C0010294:Creatinine, C0017725:Glucose, C0040134:thyroid (USP), C0019932:Hormones, C0015663:Fasting, C0023779:Lipids, C0023767:Lipid A, C0023884:Liver, C0700205:Function Axis, C0009555:Complete Blood Count, C0005773:Blood Cells, C0005771:Blood Cell Count, C0007584:Cell Count, C0202020:Folic acid measurement, serum, C0036792:Copper measurement, serum, C0201937:Carnitine measurement, serum, C0202004:Estriol measurement, serum, C0202041:Glucose measurement, serum, C0236281:Serum lithium measurement, C0427433:Serum TIBC measurement, C0108127:calcium magnesium phosphate, C2604770:calcium magnesium carbonate, C0600137:Blood Urea Nitrogen, C0428282:Serum creatinine low, C0438243:Serum creatinine abnormal, C0438244:Serum creatinine normal, C0600061:Serum creatinine level, C0700225:Serum creatinine raised, C0026667:Melanocyte stimulating hormone, C0733758:Follicle Stimulating Hormone, C0430044:Fasting lipid profile, C0232741:Liver function, C0022662:Kidney Function Tests, C0023901:Liver Function Tests, C0430152:Gastric function tests, C0587355:Electrolytes measurement, serum, C0202230:Thyroid stimulating hormone measurement, C1295607:Decreased thyroid stimulating hormone level |
| 32475 | Serial monitoring, when indicated, should include serum electrolyte levels and renal function. | C2946261:"Level", C1287347:"Finding of serum electrolyte levels", C0181904:"Monitor Device", C0229671:"Serum", C0013832:"Electrolytes" | C4554600:Serial, C0015945:Fetal Monitoring, C1444656:Indicated, C0229671:Serum, C0013832:Electrolytes, C3536863:Electrolyte [EPC], C0304459:Electrolyte agent, C0700205:Function Axis, C0428284:Electrolyte levels - finding, C0232804:Renal function, C1287347:Finding of serum electrolyte levels |
| 32476 | A 12-lead electrocardiogram should be performed initially on all patients presenting with Heart Failure | C0023175:"Lead", C1623258:"Electrocardiography", C0013798:"Electrocardiogram" | C0023175:Lead, C0013798:Electrocardiogram, C0884358:Performed, C0205265:Initially, C0444868:All, C0030705:Patients, C0426109:Caput presenting, C0430456:12 lead ECG, C0179504:Electrocardiogram lead (device), C0199557:Electrocardiogram, single lead, C0199558:Electrocardiogram, esophageal lead, C2960418:12 lead electrocardiogram at rest, C2960419:12 lead electrocardiogram during exercise |
| 32477 | Screening for hemochromatosis or HIV is reasonable in selected patients who present with Heart Failure. | C0018995:"Hemochromatosis", C0220908:"Screening procedure" | C1710032:Screening, C0018995:Hemochromatosis, C0019682:HIV, C0030705:Patients, C0150312:Present, C1303095:Hemochromatosis gene screening test |
| 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:"Amyloidosis", C0031511:"Pheochromocytoma", C0012634:"Disease" | C0348026:Diagnostic, C0012634:Disease, C0003462:Anus Diseases, C0002726:Amyloidosis, C0031511:Pheochromocytoma, C0030705:Patients, C0426109:Caput presenting, C0205210:Clinical, C0242114:Suspicion |
| 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. | C1273070:"Left ventricular diastolic dysfunction", C0030956:"Peptides", C0220908:"Screening procedure", C1277187:"Left ventricular systolic dysfunction" | C0030705:Patients, C0035647:Risk, C0227024:Developing tooth, C0597421:natriuretic, C0030956:Peptides, C0388060:peptide A, C0006558:C-Peptide, C2349100:Valid Biomarker, C1710032:Screening, C0332283:Followed by, C4697860:Not Followed, C0559897:Diet followed, C0871489:Team, C0007226:Cardiovascular system, C3887460:Cardiovascular, C1611835:Specialist, C3827682:Useful, C1527148:Development, C0205091:Left, C1522565:Ventricular, C3887504:Dysfunction, C0039155:Systole, C0442710:Peak systolic, C0489485:end systolic, C0012000:Diastole, C0442709:end diastolic, C0205314:New, C0081880:Natriuretic Peptide, C-Type, C0080310:Left Ventricular Function, C0199646:Left ventricular recording, C0225897:Left ventricular structure, C0232327:Left ventricular ST changes, C0397282:Left ventricular operation, C1273070:Left ventricular diastolic dysfunction, C1997351:Left ventricular cardiac dysfunction, C3532309:Fetal ventricular dysfunction, C3532310:Fetal right ventricular dysfunction, C3532311:Fetal left ventricular dysfunction, C0749225:Systolic dysfunction, C1277187:Left ventricular systolic dysfunction, C3266750:Mild left ventricular systolic dysfunction, C1562095:Right ventricular systolic dysfunction, C3266752:Moderate left ventricular systolic dysfunction, C3266753:Severe left ventricular systolic dysfunction, C2711489:Combined systolic and diastolic dysfunction, C1271082:No evidence of left ventricular systolic dysfunction, C3698411:Asymptomatic left ventricular systolic dysfunction, C1319789:Echocardiogram shows left ventricular systolic dysfunction |
| 32480 | In patients presenting with dyspnea, measurement of natriuretic peptide biomarkers is useful to support a diagnosis or exclusion of Heart Failure. | C0011900:"Diagnosis", C0030956:"Peptides", C0013404:"Dyspnea" | C0030705:Patients, C0426109:Caput presenting, C0013404:Dyspnea, C0242485:Measurement, C0597421:natriuretic, C0030956:Peptides, C0388060:peptide A, C0006558:C-Peptide, C0041366:Biomarkers, Tumor, C3827682:Useful, C0011900:Diagnosis, C2828389:Exclusion, C0081880:Natriuretic Peptide, C-Type, C4518809:Diagnosis of exclusion, C1095989:Brain natriuretic peptide measurement, C1446047:Plasma B natriuretic peptide measurement |
| 32481 | Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic Heart Failure. | C0033325:"Forecast of outcome", C0012634:"Disease" | C0242485:Measurement, C3827682:Useful, C0443211:Established, C0150735:Establishing Rapport, C2364239:Establishing Trust, C0278250:Prognosis good, C0278251:Fair prognosis, C0278252:Prognosis bad, C0012634:Disease, C0205191:chronic |
| 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. | C2946261:"Level", C0184666:"Hospital admission", C0041199:"Troponin", C0033325:"Forecast of outcome", C0030956:"Peptides" | C0242485:Measurement, C1442488:Baseline, C0597421:natriuretic, C0030956:Peptides, C0388060:peptide A, C0006558:C-Peptide, C0041366:Biomarkers, Tumor, C0041199:Troponin, C0457453:On admission, C4533677:at admission, C0559269:Pre-admission, C0019994:Hospitals, C4035588:Hospital-OR, C3827682:Useful, C0443211:Established, C0511063:Establish goals, C0677368:Establish fees, C0278250:Prognosis good, C0278251:Fair prognosis, C0278252:Prognosis bad, C0205434:Decompensated, C0081880:Natriuretic Peptide, C-Type, C1305957:Cardiac troponin I, C0184666:Hospital admission, C0184680:Hospital admission, special |
| 32483 | During a Heart Failure hospitalization, a predischarge natriuretic peptide level can be useful to establish a postdischarge prognosis. | C2946261:"Level", C0033325:"Forecast of outcome", C0030956:"Peptides" | C0347984:During, C0019993:Hospitalization, C0597421:natriuretic, C0030956:Peptides, C0388060:peptide A, C0006558:C-Peptide, C2946261:Level, C3827682:Useful, C0443211:Established, C0511063:Establish goals, C0677368:Establish fees, C0278250:Prognosis good, C0278251:Fair prognosis, C0278252:Prognosis bad, C0081880:Natriuretic Peptide, C-Type, C1318675:Plasma pro-brain natriuretic peptide level, C1319570:Serum pro-brain natriuretic peptide level |
| 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:"Fibrosis", C0175677:, C3263723:"Traumatic injury", C3263722:"Traumatic AND/OR non-traumatic injury", C0449210:"OTH tumor staging notation" | C0030705:Patients, C0205191:chronic, C0242485:Measurement, C0205394:Other, C1511733:Date Available, C0041366:Biomarkers, Tumor, C0027061:Myocardium, C1522564:Myocardial, C0016059:Fibrosis, C0750591:consider, C0442796:Additive, C0035647:Risk, C1514983:Stratification |
| 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. | C0018799:"Heart Diseases", C0018787:"Heart", C0700148:"Congestion", C0039985:"Plain chest X-ray", C1962945:"Radiographic imaging procedure", C0449210:"OTH tumor staging notation", C1306645:"Plain x-ray", C0242073:"Pulmonary congestion", C0817096:"Chest", C0012634:"Disease", C1457887:"Symptoms", C1281570:"Entire heart" | C0030705:Patients, C1997218:NOT suspected, C0205314:New, C0426109:Caput presenting, C0205178:acute, C0205434:Decompensated, C0817096:Chest, C1516048:Assessed, C0018787:Heart, C0456389:size, C0700148:Congestion, C1330713:EZ Detect, C1523987:Alternative, C0205394:Other, C0012634:Disease, C0003462:Anus Diseases, C1880177:Contribution, C1457887:Symptoms, C0242073:Pulmonary congestion |
| 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. | C1261322:"Evaluation procedure", C0013516:"Echocardiography", C0554756:"Doppler studies" | C0450363:Three-dimensional, C1705052:2-Dimensional, C0013516:Echocardiography, C2243117:Echocardiogram (image), C0436484:Echocardiogram normal, C0476369:Echocardiogram abnormal, C0743380:echocardiogram result, C1319340:Echocardiogram declined, C0884358:Performed, C0347984:During, C0205265:Initially, C0220825:Evaluation, C0030705:Patients, C0426109:Caput presenting, C1516048:Assessed, C1522565:Ventricular, C0700205:Function Axis, C0456389:size, C0026597:Motion, C0080310:Left Ventricular Function, C0080311:Ventricular Function, Right, C1287715:Left ventricular function - finding, C0428789:Aortic valve function, C0428799:Mitral valve function, C0588136:Heart valve function |
| 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. | C0087111:"Therapeutic procedure" | C0205341:Repeat, C0242485:Measurement, C0678594:Structure, C0017366:Structural gene, C0085268:Bone remodeling, C3827682:Useful, C1533716:Information, C0030705:Patients, C0750502:Significant, C0205210:Clinical, C0449438:Status, C1546957:Fully recovered, C0441471:Event, C1514756:Receive, C1709850:Received By, C0729795:Fax received, C1115441:Date received, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C1280500:Effect, C0700205:Function Axis, C0699733:Devices, C0003827:Art Therapy, C0449440:Clinical status, C0232164:Cardiac function |
| 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:"Ischemia", C0011923:"Diagnostic Imaging", C0581603:"Revascularization - action", C0151744:"Myocardial Ischemia", C0002962:"Angina Pectoris" | C2986496:Noninvasive, C1330713:EZ Detect, C0027061:Myocardium, C1522564:Myocardial, C0022116:Ischemia, C0015954:Fetal Viability, C0449583:Viability of gut, C1300991:Tumor viability, C1442040:Viability count, C0030705:Patients, C0426109:Caput presenting, C0205309:Known, C1548635:Eligible, C0581603:Revascularization - action, C0007794:Cerebral Revascularization, C0027056:Myocardial Revascularization, C0472662:Limb revascularization, C0472665:Revascularization of forearm, C0472666:Revascularization of hand, C0472667:Revascularization of thumb, C0472668:Revascularization of finger, C0472672:Revascularization of foot, C1552551:Any, C0151744:Myocardial Ischemia |
| 32489 | Viability assessment is reasonable in select situations when planning revascularization in Heart Failure patients with CAD. | C1261322:"Evaluation procedure", C0581603:"Revascularization - action" | C0015954:Fetal Viability, C0449583:Viability of gut, C1300991:Tumor viability, C1442040:Viability count, C1651012:Select-OB, C2730299:PNV Select, C0008866:City Planning, C0581603:Revascularization - action, C0007794:Cerebral Revascularization, C0027056:Myocardial Revascularization, C0472662:Limb revascularization, C0472665:Revascularization of forearm, C0472666:Revascularization of hand, C0472667:Revascularization of thumb, C0472668:Revascularization of finger, C0472672:Revascularization of foot, C0030705:Patients |
| 32490 | Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate. | C0024485:"Magnetic Resonance Imaging", C0034610:"Radionuclide Ventriculography", C0013516:"Echocardiography", C0011923:"Diagnostic Imaging", C0231881:"Pulmonary resonance" | C0034606:Radionuclide Imaging, C0007800:Cerebral Ventriculography, C0596683:Cardiac ventriculography, C0846023:Right ventriculography, C0042516:Ventriculography, First-Pass, C0563532:Magnetism, C0427170:Magnetic gait, C0681512:magnetic tape, C0314720:Vocal resonance, C3827682:Useful, C1516048:Assessed, C0449468:Volume, C0013516:Echocardiography, C0034610:Radionuclide Ventriculography, C0024485:Magnetic Resonance Imaging |
| 32491 | Magnetic resonance imaging is reasonable when assessing myocardial infiltrative processes or scar burden. | C0024485:"Magnetic Resonance Imaging", C0011923:"Diagnostic Imaging", C2004491:"Cicatrix", C0231881:"Pulmonary resonance" | C0563532:Magnetism, C0427170:Magnetic gait, C0681512:magnetic tape, C0314720:Vocal resonance, C0027061:Myocardium, C1522564:Myocardial, C0018265:Group Processes, C2828008:Burden, C0024485:Magnetic Resonance Imaging |
| 32492 | Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should NOT be performed. | C1261322:"Evaluation procedure", C1689985:"Absence (morphologic abnormality)", C1273869:"Intervention regimes" | C0205547:Routine, C0205341:Repeat, C0242485:Measurement, C0700205:Function Axis, C0205210:Clinical, C0449438:Status, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C0886296:Nursing interventions, C0010332:Crisis Intervention, C0884358:Performed, C2732244:School function assessment, C2959524:School function assessment score, C0449440:Clinical status, C0442739:No status change, C0419902:Endocrine treatment change, C0445106:Not performed |
| 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. | C0034052:"Pulmonary artery structure", C0181904:"Monitor Device", C0729936:"Cardiac chamber structure", C1269026:"Entire pulmonary artery", C0150264:"Invasive hemodynamic monitoring (regime/therapy)", C0302614:"Guide device", C0003842:"Arteries", C0179790:"Swan-Ganz catheter, device", C0460139:"Pressure (finding)", C1261322:"Evaluation procedure", C0031001:"Perfusion (procedure)", C0161959:"Cardiovascular monitoring", C0085590:"catheter device", C0476273:"Respiratory distress", C0087111:"Therapeutic procedure" | C0205281:Invasive, C0019010:Hemodynamics, C0489837:Hemodynamic method, C0919772:Hemodynamic test, C0015945:Fetal Monitoring, C0884358:Performed, C0003827:Art Therapy, C0030705:Patients, C0521346:respiratory, C0231303:Distress, C0205210:Clinical, C3887511:Evidence, C0221099:Impaired, C4281794:Perfusion route, C0029704:Other perfusion, C1979886:Excess, C0001876:Air Pressure, C0521095:Determined by, C0521096:Not determined by, C4082936:Hemodynamic Monitoring, C0034052:Pulmonary artery structure, C0009681:Anomalous pulmonary artery, C0155676:Pulmonary artery aneurysm, C0160696:Injury of pulmonary artery, C0183290:Pulmonary artery shunt, C0190693:Banding of pulmonary artery, C0202910:Pulmonary Arteriogram, C0226054:Right pulmonary artery, C0226069:Left pulmonary artery, C1321092:Hepatic artery catheter, C0476273:Respiratory distress, C1273714:Grade cannot be determined, C0150264:Invasive hemodynamic monitoring (regime/therapy), C0199629:Pulmonary artery pressure monitoring, C0204916:Pulmonary artery wedge pressure monitoring, C0179732:Pulmonary artery catheter, oximetric, C0179790:Pulmonary artery flotation catheter, C0190658:Pulmonary Artery Catheterization, C1827218:Pulmonary artery catheter care, C1828314:Removal of pulmonary artery catheter, C3882333:Pulmonary artery catheter, standard, C4544782:Assessment of pulmonary artery catheter |
| 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. | C0040732:"Transplantation", C0181904:"Monitor Device", C0460139:"Pressure (finding)", C0183683:"Support, device", C0450442:"Agent", C0031001:"Perfusion (procedure)", C0150264:"Invasive hemodynamic monitoring (regime/therapy)", C0161959:"Cardiovascular monitoring", C0344211:"Supportive care", C0087111:"Therapeutic procedure", C1457887:"Symptoms" | C0205281:Invasive, C0019010:Hemodynamics, C0489837:Hemodynamic method, C0919772:Hemodynamic test, C0015945:Fetal Monitoring, C3827682:Useful, C0030705:Patients, C0205178:acute, C0205322:Persistent, C1457887:Symptoms, C1880496:Empiric, C0449438:Status, C4281794:Perfusion route, C0029704:Other perfusion, C0205373:Systemic, C1801960:Vascular, C4281815:Resistance, C0087130:Uncertainty, C0426068:Uncertain lie, C0747001:ONSET UNCERTAIN, C1519761:Uncertain Risk, C0039155:Systole, C0442710:Peak systolic, C0489485:end systolic, C1882095:No Pressure, C0001876:Air Pressure, C0205251:low, C0332281:Associated with, C0205265:Initially, C0003827:Art Therapy, C0700205:Function Axis, C1980011:Vasoactive, C0027552:Needs, C0518609:Consideration, C0428971:Circulatory time, C0444720:Circulatory arrest, C0040732:Transplantation, C4082936:Hemodynamic Monitoring, C0456261:Pulmonary Vascular Resistance, C0429119:Vascular resistance (finding), C0042380:Vascular resistance, C0871470:Systolic Pressure, C0232804:Renal function, C0150264:Invasive hemodynamic monitoring (regime/therapy) |
| 32495 | When ischemia may be contributing to Heart Failure, coronary arteriography is reasonable for patients eligible for revascularization. | C0085532:"Coronary angiography", C0022116:"Ischemia", C0003844:"Arteriography", C0581603:"Revascularization - action" | C0022116:Ischemia, C1880177:Contribution, C4716486:Contributing factors, C1522318:Coronary, C0003844:Arteriography, C0030705:Patients, C1548635:Eligible, C0581603:Revascularization - action, C0007794:Cerebral Revascularization, C0027056:Myocardial Revascularization, C0472662:Limb revascularization, C0472665:Revascularization of forearm, C0472666:Revascularization of hand, C0472667:Revascularization of thumb, C0472668:Revascularization of finger, C0472672:Revascularization of foot, C0085532:Coronary angiography, C0436418:Coronary arteriography awaited, C0436469:Coronary arteriography normal, C0436525:Coronary arteriography abnormal, C0565183:Right coronary arteriography, C0565184:Left coronary arteriography, C1445885:Coronary arteriography declined |
| 32496 | Endomyocardial biopsy can be useful in patients presenting with Heart Failure when a specific diagnosis is suspected that would influence therapy. | C0189785:"Endomyocardial biopsy (procedure)", C0011900:"Diagnosis", C0087111:"Therapeutic procedure", C0005558:"Biopsy" | C0264666:Endomyocardial disease, C0553980:Endomyocardial Fibrosis, C0005558:Biopsy, C3827682:Useful, C0030705:Patients, C0426109:Caput presenting, C0011900:Diagnosis, C1997218:NOT suspected, C4054723:Influence, C0003827:Art Therapy, C0189785:Endomyocardial biopsy (procedure) |
| 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. | C2712122:"Normal blood pressure", C0181904:"Monitor Device", C0042402:"Vasodilator Agents", C0700148:"Congestion", C0522563:"Acute congestion", C0150264:"Invasive hemodynamic monitoring (regime/therapy)", C0161959:"Cardiovascular monitoring", C0012798:"Diuretics" | C0205547:Routine, C0205281:Invasive, C0019010:Hemodynamics, C0489837:Hemodynamic method, C0919772:Hemodynamic test, C0015945:Fetal Monitoring, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C0205178:acute, C0205434:Decompensated, C0700148:Congestion, C0231220:Symptomatic, C4282382:No response, C0012798:Diuretics, C2010769:general vasodilators, C4082936:Hemodynamic Monitoring, C0150264:Invasive hemodynamic monitoring (regime/therapy) |
| 32498 | Endomyocardial biopsy should NOT be performed in the routine evaluation of patients with Heart Failure. | C1261322:"Evaluation procedure", C0189785:"Endomyocardial biopsy (procedure)", C0005558:"Biopsy" | C0264666:Endomyocardial disease, C0553980:Endomyocardial Fibrosis, C0005558:Biopsy, C0884358:Performed, C0205547:Routine, C0220825:Evaluation, C0030705:Patients, C0189785:Endomyocardial biopsy (procedure), C0445106:Not performed |
| 32499 | Hypertension and lipid disorders should be controlled in accordance with contemporary guidelines to lower the risk of Heart Failure. | C0020538:"Hypertensive disease", C0023779:"Lipids", C0012634:"Disease" | C1963138:Hypertension, CTCAE, C2748577:No hypertension, C0020541:Portal Hypertension, C0023779:Lipids, C0023767:Lipid A, C0205318:Uncontrolled, C0332298:Controlled by, C0681703:contemporary history, C0162791:Guidelines, C0035647:Risk |
| 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. | C0028754:"Obesity", C1112669:, C0011849:"Diabetes Mellitus", C0450442:"Agent", C0449210:"OTH tumor staging notation", C0040329:"Tobacco" | C0205394:Other, C0023175:Lead, C1880177:Contribution, C0028754:Obesity, C0011847:Diabetes, C0040329:Tobacco, C0205309:Known, C1956032:Cardiotoxins, C0205318:Uncontrolled, C0332298:Controlled by, C0455373:FH: Obesity, C0455493:H/O: obesity, C0011849:Diabetes Mellitus, C3853727:Tobacco user |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0262926:"Medical History", C0014442:"Enzymes", C0948089:"Acute Coronary Syndrome", C0022709:"Peptidyl-Dipeptidase A", C0597357:"receptor", C0039082:"Syndrome", C0034787:"Angiotensin Receptor", C0003018:"Angiotensins" | C0444868:All, C0030705:Patients, C0332185:Recent, C0205157:Remote, C0019664:History, C0205178:acute, C1522318:Coronary, C0039082:Syndrome, C0392756:Reduced, C0003018:Angiotensins, C4521302:Angiotensin-1, human, C1873000:angiotensin A, C0003001:Angiotensin Amide, C0003006:Angiotensin I, C0003009:angiotensin II, C0003012:Angiotensin III, C0014442:Enzymes, C0009235:Coenzymes, C0243077:inhibitors, C0231220:Symptomatic, C0008083:Child Mortality, C0231200:intolerant, C0597357:receptor, C1548787:Appropriate, C1444657:Contraindicated, C0340678:Coronary steal syndrome, C0948089:Acute Coronary Syndrome, C0034787:Angiotensin Receptor, C0003015:Angiotensin-Converting Enzyme Inhibitors, C0201888:Angiotensin converting enzyme measurement, C0580937:Serum angiotensin-converting enzyme measurement, C1272105:CSF: angiotensin-converting enzyme level, C1277183:Angiotensin converting enzyme inhibitor declined, C1444755:Angiotensin converting enzyme inhibitor therapy |
| 32502 | In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, angiotensin-converting enzyme (ACE) inhibitors should be used to prevent symptomatic Heart Failure and reduce mortality. In patients intolerant of ACE inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0262926:"Medical History", C0014442:"Enzymes", C0948089:"Acute Coronary Syndrome", C0022709:"Peptidyl-Dipeptidase A", C0597357:"receptor", C0039082:"Syndrome", C0034787:"Angiotensin Receptor", C0003018:"Angiotensins" | C0444868:All, C0030705:Patients, C0332185:Recent, C0205157:Remote, C0019664:History, C0205178:acute, C1522318:Coronary, C0039082:Syndrome, C0392756:Reduced, C0003018:Angiotensins, C4521302:Angiotensin-1, human, C1873000:angiotensin A, C0003001:Angiotensin Amide, C0003006:Angiotensin I, C0003009:angiotensin II, C0003012:Angiotensin III, C0014442:Enzymes, C0009235:Coenzymes, C0243077:inhibitors, C0231220:Symptomatic, C0008083:Child Mortality, C0231200:intolerant, C0597357:receptor, C1548787:Appropriate, C1444657:Contraindicated, C0340678:Coronary steal syndrome, C0948089:Acute Coronary Syndrome, C0034787:Angiotensin Receptor, C0003015:Angiotensin-Converting Enzyme Inhibitors, C0201888:Angiotensin converting enzyme measurement, C0580937:Serum angiotensin-converting enzyme measurement, C1272105:CSF: angiotensin-converting enzyme level, C1277183:Angiotensin converting enzyme inhibitor declined, C1444755:Angiotensin converting enzyme inhibitor therapy |
| 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. | C0262926:"Medical History", C0948089:"Acute Coronary Syndrome", C0039082:"Syndrome" | C0444868:All, C0030705:Patients, C0332185:Recent, C0205157:Remote, C0019664:History, C0205178:acute, C1522318:Coronary, C0039082:Syndrome, C0392756:Reduced, C3887511:Evidence, C0008083:Child Mortality, C0340678:Coronary steal syndrome, C0948089:Acute Coronary Syndrome |
| 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. | C0262926:"Medical History", C0948089:"Acute Coronary Syndrome", C1320716:"Cardiovascular event", C0039082:"Syndrome", C0360714:"Hydroxymethylglutaryl-CoA Reductase Inhibitors" | C0444868:All, C0030705:Patients, C0332185:Recent, C0205157:Remote, C0019664:History, C0205178:acute, C1522318:Coronary, C0039082:Syndrome, C0231220:Symptomatic, C0007226:Cardiovascular system, C3887460:Cardiovascular, C0441471:Event, C0340678:Coronary steal syndrome, C0948089:Acute Coronary Syndrome |
| 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. | C0262926:"Medical History", C0020538:"Hypertensive disease", C0460139:"Pressure (finding)", C0149721:"Left Ventricular Hypertrophy", C1272641:"Systemic arterial pressure", C1689985:"Absence (morphologic abnormality)", C0020564:"Hypertrophy", C0005767:"Blood" | C0030705:Patients, C0678594:Structure, C0017366:Structural gene, C3809765:No abnormalities, C0015393:Eye Abnormalities, C0020564:Hypertrophy, C0019664:History, C0005767:Blood, C1882095:No Pressure, C0001876:Air Pressure, C0205318:Uncontrolled, C0332298:Controlled by, C0205210:Clinical, C0162791:Guidelines, C1963138:Hypertension, CTCAE, C2748577:No hypertension, C0020541:Portal Hypertension, C0231220:Symptomatic, C0005823:Blood Pressure, C0445199:Pressure controlled method, C0564626:Pressure controlled ventilation, C0564627:Pressure controlled SIMV |
| 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. | C0262926:"Medical History", C0003015:"Angiotensin-Converting Enzyme Inhibitors" | C0243077:inhibitors, C0444868:All, C0030705:Patients, C0392756:Reduced, C0231220:Symptomatic, C0019664:History, C0332124:No past history |
| 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. | C0262926:"Medical History" | C0444868:All, C0030705:Patients, C0392756:Reduced, C0231220:Symptomatic, C0019664:History, C0332124:No past history |
| 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. | C0878544:"Cardiomyopathies", C0418981:"Medical therapy", C1533810:"Placement action", C0441587:"Clinical act of insertion", C0011071:"Sudden death", C0087111:"Therapeutic procedure", C1306577:"Death (finding)", C0349782:"Ischemic cardiomyopathy", C0231221:"Asymptomatic" | C1524072:Placement, C0491196:Clips, Implantable, C0491261:STAPLE, IMPLANTABLE, C0030705:Patients, C0231221:Asymptomatic, C0475224:Ischemic, C0878544:Cardiomyopathies, C1837350:No cardiomyopathy, C0007193:Cardiomyopathy, Dilated, C0007930:Chagas Cardiomyopathy, C0439509:/40, C3842587:40%, C0439228:day, C0687676:Post, C3842588:30%, C1548787:Appropriate, C0205476:Medical, C0003827:Art Therapy, C0679138:Expectations, C0679142:Role Expectations, C0007620:Cell Survival, C0038954:Survival Rate, C0205170:Good, C0205245:Functional, C0449438:Status, C0439234:year, C0011071:Sudden death, C0349782:Ischemic cardiomyopathy, C0418981:Medical therapy, C0451175:Functional status index, C4304688:Decline in functional status |
| 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. | C0006684:"Calcium Channel Blockers", C0006675:"Calcium", C0231221:"Asymptomatic", C1457887:"Symptoms" | C0006675:Calcium, C0439799:Channel, C0205160:Negative, C0304509:Inotropic agent, C1280500:Effect, C1704420:effects of, C0231221:Asymptomatic, C0030705:Patients, C0205251:low, C1457887:Symptoms, C1153433:calcium channel activity, C0006684:Calcium Channel Blockers, C0231918:Nose symptoms, C0452117:Poisoning by calcium-channel blockers, C0573229:Overdose of calcium-channel blockers |
| 32510 | Patients with Heart Failure should receive specific education to facilitate Heart Failure self-care. | C0039401:"Educational process of instructing", C0013658:"Educational Status", C0424927:"Details of education" | C0030705:Patients, C1514756:Receive, C0036588:Self |
| 32511 | Sodium restriction is reasonable for patients with symptomatic Heart Failure to reduce congestive symptoms. | C0037473:"Sodium", C1457887:"Symptoms" | C0037473:Sodium, C0150136:Area restriction, C0204700:Fluid restriction, C0849760:chest restriction, C0030705:Patients, C0231220:Symptomatic, C0742742:Congestive, C1457887:Symptoms, C0430141:Sodium restriction test |
| 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. | C0220931:"Training" | C0015259:Exercise, C0220931:Training, C0205272:Regular, C0205485:Physical, C3845261:No activity, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C1280519:Effectiveness, C1704419:Effective, C0030705:Patients, C0184511:Improved, C0205245:Functional, C0449438:Status, C0026606:Physical activity, C0451175:Functional status index, C4304688:Decline in functional status |
| 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. | C1998319:"Functional capacity", C0518214:"Perceived quality of life", C0034991:"Rehabilitation therapy", C0700431:"Cardiac rehabilitation", C2926735:"Duration" | C0034991:Rehabilitation therapy, C0034992:Rehabilitation aspects, C0026643:Mouth Rehabilitation, C0034993:Rehabilitation Centers, C3827682:Useful, C0038371:Stable Fly, C0030705:Patients, C0184511:Improved, C0205245:Functional, C1516240:Capacity, C0015259:Exercise, C2926735:Duration, C0018684:Health, C1546988:Not related, C0332306:Quality, C0376558:Life, C0008083:Child Mortality, C0700431:Cardiac rehabilitation, C1998319:Functional capacity |
| 32515 | GDMT as depicted in Figure 1 should be the mainstay of pharmacological therapy for Heart FailurerEF. (I-A) < | C0087111:"Therapeutic procedure" | C0031330:Pharmacology, C0205464:pharmacological, C0003827:Art Therapy |
| 32516 | Heart FailurerEF NYHA class I?IV (Stage C) ACEI or ARB AND GDMT beta blocker; diuretics as needed (COR I) | C0028778:"Obstruction", C0012798:"Diuretics" | C0456387:Class, C1306673:Stage, C0012798:Diuretics, C1444650:Not needed, C1883728:As Needed |
| 32517 | NYHA class II?IV, provided est. CrCl >30 mL/min & K+ <5.0 mEq/L implement Aldosterone antagonist (COR I) | C0002007:"Aldosterone Antagonists", C0002006:"Aldosterone" | C0456387:Class, C3661900:Not provided, C2735418:Care provided, C3842588:30%, C0439526:/mL, C0439152:mEq, C0002006:Aldosterone, C0439445:mL/min, C0439402:mL/min/kg, C1641597:mL/min/SA, C0002007:Aldosterone Antagonists |
| 32519 | NYHA class III?IV, in black patients implment Hydral-Nitrates | C0028125:"Nitrates" | C0456387:Class, C0030705:Patients, C0028125:Nitrates |
| 32520 | NYHA class II?III, LVEF ?35%; (caveat: >1 y survival, >40 d post MI) implement implantable cardioverter-defibrillator | C0162589:"Implantable defibrillator", C0180307:"Defibrillators" | C0456387:Class, C4319605:35, C0007620:Cell Survival, C0038954:Survival Rate, C0439509:/40, C3842587:40%, C0687676:Post, C0491196:Clips, Implantable, C0491261:STAPLE, IMPLANTABLE, C0948944:Cardioverter removal, C0180307:Defibrillators, C0180297:Testers, Defibrillator, C0180301:Defibrillator paddle, C1289801:Implantable cardioverter leads, C1960586:Cardioverter defibrillator procedure, C1998273:Replacement of cardioverter defibrillator, C0189873:Relocation of automatic implantable cardioverter/defibrillator, C0189874:Revision of automatic implantable cardioverter/defibrillator, C4039082:Malfunction of automatic implantable cardioverter defibrillator |
| 32522 | NYHA class II?III, NSR, heart rate ?70 bpm on maximally tolerated dose beta blocker | C0028778:"Obstruction", C0018787:"Heart", C1281570:"Entire heart" | C0456387:Class, C0018787:Heart, C1521828:Rate, C3842584:70%, C0018810:heart rate |
| 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 | C0040732:"Transplantation", C0332835:"Transplanted tissue", C0181598:"Left ventricular assist device", C0085842:"Artificial Ventricle", C0030231:"Palliative Care", C0087111:"Therapeutic procedure" | C0030705:Patients, C1306673:Stage, C0349412:Refractory shock, C0456387:Class, C0750591:consider, C1524062:Additional, C0003827:Art Therapy, C1285530:Palliative, C0040732:Transplantation, C3841811:Transplant, C0205091:Left, C1522565:Ventricular, C0699733:Devices, C1517586:Investigational, C0030231:Palliative Care, C0080310:Left Ventricular Function, C0199646:Left ventricular recording, C0225897:Left ventricular structure, C0232327:Left ventricular ST changes, C0397282:Left ventricular operation, C0181598:Left ventricular assist device, C4518462:Left ventricular assist device present, C0397128:Implantation of ventricular assist device, C1960585:Removal of ventricular assist device, C1960964:Open removal of ventricular assist device |
| 32524 | Diuretics are recommended in patients with Heart FailurerEF with fluid retention | C0268000:"Body fluid retention", C0012798:"Diuretics" | C0012798:Diuretics, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C4697984:No retention, C0268000:Body fluid retention, C3532160:Fetal fluid retention |
| 32525 | ACE inhibitors are recommended for all patients with Heart FailurerEF | C0003015:"Angiotensin-Converting Enzyme Inhibitors" | C0243077:inhibitors, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0444868:All, C0030705:Patients |
| 32526 | ARBs are recommended in patients with Heart FailurerEF who are ACE inhibitor–intolerant | C0003015:"Angiotensin-Converting Enzyme Inhibitors" | C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C1999216:Inhibitor, C0231200:intolerant |
| 32527 | ARBs are reasonable as alternatives to ACE inhibitors as first-line therapy in Heart FailurerEF | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0087111:"Therapeutic procedure" | C0002345:Alternative Splicing, C0517294:Weighs alternatives, C0243077:inhibitors, C1279901:Firstly, C0003827:Art Therapy |
| 32529 | Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with Heart FailurerEF. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0002007:"Aldosterone Antagonists", C0002006:"Aldosterone" | C0205547:Routine, C0205195:Combined, C1999216:Inhibitor, C0002006:Aldosterone, C0030705:Patients, C0002007:Aldosterone Antagonists |
| 32531 | Aldosterone receptor antagonists are recommended in patients with NYHA class II–IV Heart Failure who have LVEF ?35% | C0597357:"receptor", C0002007:"Aldosterone Antagonists", C0002006:"Aldosterone" | C0002006:Aldosterone, C0597357:receptor, C0243076:antagonists, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C0456387:Class, C4319605:35, C0522271:Aldosterone receptor site |
| 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. | C0262926:"Medical History", C0011849:"Diabetes Mellitus", C0597357:"receptor", C0002007:"Aldosterone Antagonists", C1457887:"Symptoms", C0002006:"Aldosterone" | C0002006:Aldosterone, C0597357:receptor, C0243076:antagonists, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality, C0332282:Following, C0205178:acute, C0030705:Patients, C0439509:/40, C3842587:40%, C1457887:Symptoms, C0019664:History, C0011847:Diabetes, C1444657:Contraindicated, C0522271:Aldosterone receptor site, C0455678:No family history diabetes, C0011849:Diabetes Mellitus, C0455488:H/O: diabetes mellitus, C1313937:Family history of diabetes mellitus, C3874269:Maternal history of diabetes mellitus, C3532488:History of diabetes mellitus type 2, C3532489:History of diabetes mellitus type 1 |
| 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. | C0010294:"Creatinine", C0017654:"Glomerular Filtration Rate", C0229671:"Serum", C0035078:"Kidney Failure", C0201976:"Creatinine measurement, serum (procedure)", C0020461:"Hyperkalemia", C0597357:"receptor", C0002007:"Aldosterone Antagonists", C0032821:"Potassium", C0002006:"Aldosterone" | C1548788:Inappropriate, C0002006:Aldosterone, C0597357:receptor, C0243076:antagonists, C0376558:Life, C2128835:verbal threatening, C2826244:Life Threatening, C0020461:Hyperkalemia, C0231179:Insufficiency, C0229671:Serum, C0010294:Creatinine, C4321396:MG, C0750572:Estimated, C0016107:filtration, C1521828:Rate, C3842588:30%, C0439526:/mL, C0032821:Potassium, C0439152:mEq, C0522271:Aldosterone receptor site, C2711184:Life threatening severity, C4544334:History of renal insufficiency, C0428282:Serum creatinine low, C0438243:Serum creatinine abnormal, C0438244:Serum creatinine normal, C0600061:Serum creatinine level, C0700225:Serum creatinine raised, C0439269:mg/dL, C0232809:Glomerular filtration, C0439445:mL/min, C0439402:mL/min/kg, C1641597:mL/min/SA, C1301862:Min 1, C0017654:Glomerular Filtration Rate |
| 32534 | The combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III–IV Heart FailurerEF on GDMT | C0022251:"Isosorbide", C0022252:"Isosorbide Dinitrate", C0020223:"Hydralazine" | C0013162:Drug Combinations, C0052142:AP combination, C0054603:CAP combination, C0020223:Hydralazine, C0022251:Isosorbide, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0003988:Asian Americans, C0010436:Cuban Americans, C0456387:Class, C0022252:Isosorbide Dinitrate |
| 32535 | A combination of hydralazine and isosorbide dinitrate can be useful in patients with Heart FailurerEF who cannot be given ACE inhibitors or ARBs | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0022251:"Isosorbide", C0022252:"Isosorbide Dinitrate", C0020223:"Hydralazine" | C0013162:Drug Combinations, C0052142:AP combination, C0054603:CAP combination, C0020223:Hydralazine, C0022251:Isosorbide, C3827682:Useful, C0030705:Patients, C1442162:GIVEN, C0243077:inhibitors, C0022252:Isosorbide Dinitrate |
| 32536 | Digoxin can be beneficial in patients with Heart FailurerEF, unless contraindicated, to decrease hospitalizations for Heart Failure. | C0012265:"Digoxin" | C0012265:Digoxin, C0030705:Patients, C1444657:Contraindicated, C0547047:Decrease, C0019993:Hospitalization, C4086639:Number of Hospitalizations |
| 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). | C0262926:"Medical History", C0020538:"Hypertensive disease", C0038454:"Cerebrovascular accident", C1304680:"Observation of attack", C1531624:"Cardioembolic stroke", C0011849:"Diabetes Mellitus", C0003280:"Anticoagulants", C0007787:"Transient Ischemic Attack", C0087111:"Therapeutic procedure", C0150457:"Anticoagulant therapy" | C0030705:Patients, C0205191:chronic, C0205355:Permanent, C0205322:Persistent, C0205311:Paroxysmal, C1524062:Additional, C0035647:Risk, C1521761:Factor, C1531624:Cardioembolic stroke, C0038819:Sunstroke, C0019664:History, C1963138:Hypertension, CTCAE, C2748577:No hypertension, C0020541:Portal Hypertension, C0011847:Diabetes, C0205156:Previous, C0475224:Ischemic, C4319621:75, C0439234:year, C3840862:75+ years, C3843647:> 2 years, C0001779:Age, C1514756:Receive, C0003280:Anticoagulants, C3536711:Anti-coagulant [EPC], C0150457:Anticoagulant therapy, C0003827:Art Therapy, C1301624:Medical contraindication, C0079164:contraindications aspect, C0683526:treatment contraindications, C0852649:Contraindications, Surgery, C1317264:Contraindications section, C3173979:Contraindications for test, C4505286:Contraindications, Drug, C4505287:Contraindications, Procedure, C0003281:Anticoagulation Therapy, C2919015:ANTICOAGULATION (finding), C0449867:Use of anticoagulation, C0694554:chronic anticoagulation, C1531589:Anticoagulation declined, C0035648:risk factors, C4038583:History of portal hypertension, C0011849:Diabetes Mellitus, C0007787:Transient Ischemic Attack, C0155530:Transient ischemic deafness, C0341425:Transient ischemic colitis, C1998164:History of cardioembolic stroke, C1446238:Stroke / transient ischemic attack referral, C1532938:Stroke/transient ischemic attack monitoring status |
| 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. ( | C0525032:"International Normalized Ratio", C1874451:"Basis", C0450442:"Agent", C0449210:"OTH tumor staging notation", C0003280:"Anticoagulants", C0043031:"Warfarin", C1831808:"apixaban", C0013227:"Pharmaceutical Preparations", C1739768:"rivaroxaban" | C0005999:Book Selection, C0016488:Food Selection, C0024909:Mate Selection, C0036577:Selection Bias, C0003280:Anticoagulants, C3536711:Anti-coagulant [EPC], C0150457:Anticoagulant therapy, C0450442:Agent, C0043031:Warfarin, C2348066:dabigatran, C1831808:apixaban, C1739768:rivaroxaban, C0205355:Permanent, C0205322:Persistent, C0205311:Paroxysmal, C1881197:Individualized, C1874451:Basis, C0035647:Risk, C0000779:ABO Factors, C0001783:Age Factors, C3274448:Tolerability Study, C0030705:Patients, C0558295:preference, C3245505:Potential, C0687133:Drug Interactions, C0242784:Food Interactions, C0205394:Other, C0205210:Clinical, C1521970:Characteristics, C0040223:Time, C1512888:International, C1882115:Normalize, C2986790:Normalized Time, C0456603:Ratio, C0302350:Therapeutic, C1514721:Range, C0455939:A/N risk factors, C0525032:International Normalized Ratio, C1272307:Target international normalized ratio, C0460092:Therapeutic range comments, C0460096:Above therapeutic range, C0460097:Within therapeutic range, C0460099:Below therapeutic range, C0332310:Has patient |
| 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). ( | C0038454:"Cerebrovascular accident", C1531624:"Cardioembolic stroke" | C0205191:chronic, C0003281:Anticoagulation Therapy, C2919015:ANTICOAGULATION (finding), C0449867:Use of anticoagulation, C0694554:chronic anticoagulation, C1531589:Anticoagulation declined, C0030705:Patients, C0205355:Permanent, C0205322:Persistent, C0205311:Paroxysmal, C0332288:Without, C1524062:Additional, C0035647:Risk, C1521761:Factor, C1531624:Cardioembolic stroke, C0038819:Sunstroke, C1301624:Medical contraindication, C0079164:contraindications aspect, C0683526:treatment contraindications, C0852649:Contraindications, Surgery, C1317264:Contraindications section, C3173979:Contraindications for test, C4505286:Contraindications, Drug, C4505287:Contraindications, Procedure, C0035648:risk factors |
| 32540 | Anticoagulation is NOT recommended in patients with chronic Heart FailurerEF without AF, a prior thromboembolic event, or a cardioembolic source | C0449416:"Source" | C0003281:Anticoagulation Therapy, C2919015:ANTICOAGULATION (finding), C0449867:Use of anticoagulation, C0694554:chronic anticoagulation, C1531589:Anticoagulation declined, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C0205191:chronic, C0332288:Without, C0333214:thromboembolic, C0441471:Event, C1531624:Cardioembolic stroke, C0449416:Source, C1531590:Anticoagulation not indicated, C1531591:Anticoagulation not tolerated, C3839946:Anticoagulation clinic |
| 32541 | Statins are NOT beneficial as adjunctive therapy when prescribed solely for Heart Failure | C0360714:"Hydroxymethylglutaryl-CoA Reductase Inhibitors", C0087111:"Therapeutic procedure" | C1292783:Adjunctive care, C0003827:Art Therapy, C0278329:Prescribed |
| 32542 | Omega-3 PUFA supplementation is reasonable to use as adjunctive therapy in Heart FailurerEF or Heart FailurepEF patients | C0087111:"Therapeutic procedure" | C1719844:Omega, C0242297:Dietary Supplementation, C0242296:Food Supplementation, C0302837:Vitamin supplementation, C0556077:Energy supplementation, C0556086:Nitrogen supplementation, C0556088:Fat supplementation, C0556089:Choline supplementation, C1292783:Adjunctive care, C0003827:Art Therapy, C0030705:Patients |
| 32543 | Nutritional supplements as treatment for Heart Failure are NOT recommended in patients with current or prior symptoms of Heart FailurerEF. ( | C1457887:"Symptoms" | C1521739:Nutritional, C0351437:oral supplement, C0721124:Iron Supplement, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C1457887:Symptoms |
| 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). | C0051696:"Amlodipine", C1257987:"Thiazolidinediones", C0003195:"Anti-Arrhythmia Agents", C0006675:"Calcium", C0013227:"Pharmaceutical Preparations", C1457887:"Symptoms" | C0205309:Known, C0205210:Clinical, C0449438:Status, C0030705:Patients, C1457887:Symptoms, C0424092:Withdrawn, C0332149:Possible, C0205393:Most, C3537142:Antiarrhythmic [EPC], C0051989:antiarrhythmic peptide, C0006675:Calcium, C0439799:Channel, C0332206:Blocking, C0332300:Except for, C0051696:Amlodipine, C0333348:Inflammatory, C1257987:Thiazolidinediones, C0449440:Clinical status, C1153433:calcium channel activity, C0006684:Calcium Channel Blockers |
| 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 | C0354668:"Positive inotropic drug", C0013227:"Pharmaceutical Preparations", C0012634:"Disease" | C0205166:Long, C1446409:Positive, C0304509:Inotropic agent, C0030705:Patients, C0332300:Except for, C0444930:End, C1306673:Stage, C0012634:Disease, C0205476:Medical, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C0205088:End-stage, C0849833:Fear of medical treatment, C0745744:End Stage Liver Disease |
| 32547 | Calcium channel–blocking drugs are NOT recommended as routine treatment in Heart FailurerEF | C0006675:"Calcium", C0013227:"Pharmaceutical Preparations" | C0006675:Calcium, C0439799:Channel, C0332206:Blocking, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0205547:Routine, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C1153433:calcium channel activity, C0006684:Calcium Channel Blockers |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C1960108:"Renin inhibitor", C0002007:"Aldosterone Antagonists", C0035094:"Renin", C0002006:"Aldosterone", C0003018:"Angiotensins" | C0205210:Clinical, C0679199:Strategy, C3463820:Inhibition, C0035094:Renin, C0003018:Angiotensins, C4521302:Angiotensin-1, human, C1873000:angiotensin A, C0003001:Angiotensin Amide, C0003006:Angiotensin I, C0003009:angiotensin II, C0003012:Angiotensin III, C0449913:System, C0243077:inhibitors, C2699427:Conjunction, C3887511:Evidence, C0002006:Aldosterone, C0243076:antagonists, C0030705:Patients, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0205191:chronic, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality |
| 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. | C0002007:"Aldosterone Antagonists", C0035094:"Renin", C0003018:"Angiotensins", C0002006:"Aldosterone" | C0205210:Clinical, C0679199:Strategy, C3463820:Inhibition, C0035094:Renin, C0003018:Angiotensins, C4521302:Angiotensin-1, human, C1873000:angiotensin A, C0003001:Angiotensin Amide, C0003006:Angiotensin I, C0003009:angiotensin II, C0003012:Angiotensin III, C0449913:System, C2699427:Conjunction, C3887511:Evidence, C0002006:Aldosterone, C0243076:antagonists, C0030705:Patients, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0205191:chronic, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality |
| 32550 | The use of ACE inhibitors is beneficial for patients with prior or current symptoms of chronic Heart FailurerEF to reduce morbidity and mortality. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C1457887:"Symptoms" | C0243077:inhibitors, C0030705:Patients, C1457887:Symptoms, C0205191:chronic, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0002994:"Angioedema", C0010200:"Coughing", C1457887:"Symptoms" | C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C1457887:Symptoms, C0205191:chronic, C0231200:intolerant, C0243077:inhibitors, C0425502:No cough, C0002994:Angioedema |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0035139:"Surgical Replantation" | C0030705:Patients, C0205191:chronic, C0231220:Symptomatic, C0456387:Class, C1999216:Inhibitor, C0559956:Replacement, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C1517331:Further, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0597357:"receptor", C0034787:"Angiotensin Receptor", C0003018:"Angiotensins" | C0003018:Angiotensins, C4521302:Angiotensin-1, human, C1873000:angiotensin A, C0003001:Angiotensin Amide, C0003006:Angiotensin I, C0003009:angiotensin II, C0003012:Angiotensin III, C0597357:receptor, C0025250:Neprilysin, C1999216:Inhibitor, C1521801:Having administered, C1548562:Not Administered, C0243077:inhibitors, C0332285:Within, C4319606:36, C0439227:Hour, C0564385:/hour, C1517741:Last, C0034787:Angiotensin Receptor |
| 32554 | Angiotensin receptor-neprilysin inhibitor should not be administered to patients with a history of angioedema. | C0262926:"Medical History", C0002994:"Angioedema", C0597357:"receptor", C0034787:"Angiotensin Receptor", C0003018:"Angiotensins" | C0003018:Angiotensins, C4521302:Angiotensin-1, human, C1873000:angiotensin A, C0003001:Angiotensin Amide, C0003006:Angiotensin I, C0003009:angiotensin II, C0003012:Angiotensin III, C0597357:receptor, C0025250:Neprilysin, C1999216:Inhibitor, C1521801:Having administered, C1548562:Not Administered, C0030705:Patients, C0019664:History, C0002994:Angioedema, C0034787:Angiotensin Receptor, C3266719:History of angioedema |
| 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. | C0257190:"ivabradine", C0016169:"pathologic fistula", C0028778:"Obstruction", C0018787:"Heart", C0423772:"Cutaneous Fistula", C0232201:"Sinus rhythm", C1281570:"Entire heart" | C0257190:ivabradine, C0019993:Hospitalization, C0030705:Patients, C0231220:Symptomatic, C0456387:Class, C0038371:Stable Fly, C0205191:chronic, C4319605:35, C0806909:Maximum, C0871269:Rhythm, C0018787:Heart, C1521828:Rate, C3842584:70%, C0035253:Rest, C0232201:Sinus rhythm, C0018810:heart rate, C1319902:Patient on maximum tolerated dose |
| 32556 | Diuretics are recommended in patients with Heart FailurerEF who have evidence of fluid retention, unless contraindicated, to improve symptoms. | C0268000:"Body fluid retention", C0012798:"Diuretics", C1457887:"Symptoms" | C0012798:Diuretics, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C3887511:Evidence, C4697984:No retention, C1444657:Contraindicated, C0184511:Improved, C1457887:Symptoms, C0268000:Body fluid retention, C3532160:Fetal fluid retention |
| 32557 | ACE inhibitors are recommended in patients with Heart FailurerEF and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C1457887:"Symptoms" | C0243077:inhibitors, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C1457887:Symptoms, C1444657:Contraindicated, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C1457887:"Symptoms" | C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C1457887:Symptoms, C1999216:Inhibitor, C0231200:intolerant, C1444657:Contraindicated, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0449210:"OTH tumor staging notation", C0087111:"Therapeutic procedure" | C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality, C0002345:Alternative Splicing, C0517294:Weighs alternatives, C0243077:inhibitors, C1279901:Firstly, C0003827:Art Therapy, C0030705:Patients, C0205394:Other, C0521090:No indication of, C2019909:stent indications, C2093656:PTCA indications:, C1444657:Contraindicated |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0028778:"Obstruction", C0002007:"Aldosterone Antagonists", C0002006:"Aldosterone" | C0332287:In addition to, C0750591:consider, C0750508:persistently, C0231220:Symptomatic, C0030705:Patients, C1999216:Inhibitor, C0002006:Aldosterone, C1444656:Indicated, C0002007:Aldosterone Antagonists, C1444655:Not indicated |
| 32561 | Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with Heart FailurerEF. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0002007:"Aldosterone Antagonists", C0002006:"Aldosterone" | C0205547:Routine, C0205195:Combined, C1999216:Inhibitor, C0002006:Aldosterone, C0030705:Patients, C0002007:Aldosterone Antagonists |
| 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. | C2732140:"Sustain", C0053799:"Bisoprolol", C0724633:"metoprolol succinate", C0025859:"Metoprolol", C1963578:"Release (procedure)", C0054836:"carvedilol", C0220918:"succinate", C1457887:"Symptoms" | C0008083:Child Mortality, C0053799:Bisoprolol, C0054836:carvedilol, C0443318:Sustained, C0025859:Metoprolol, C0038617:Succinates, C0220918:succinate, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0444868:All, C0030705:Patients, C1457887:Symptoms, C1444657:Contraindicated, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0724633:metoprolol succinate |
| 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. | C0262926:"Medical History", C0010294:"Creatinine", C2946261:"Level", C0017654:"Glomerular Filtration Rate", C0181904:"Monitor Device", C0035078:"Kidney Failure", C0597357:"receptor", C0002007:"Aldosterone Antagonists", C0002006:"Aldosterone", C0020461:"Hyperkalemia", C0032105:"Plasma", C0030956:"Peptides", C0032821:"Potassium", C0012798:"Diuretics" | C0002006:Aldosterone, C0597357:receptor, C0243076:antagonists, C0026160:Mineralocorticoids, C0026161:Synthetic mineralocorticoid, C0066563:Mineralocorticoid Receptor, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C0456387:Class, C4319605:35, C1444657:Contraindicated, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality, C0019664:History, C0007226:Cardiovascular system, C3887460:Cardiovascular, C0019993:Hospitalization, C3163633:Elevated, C0032105:Plasma, C0597421:natriuretic, C0030956:Peptides, C0388060:peptide A, C0006558:C-Peptide, C0750591:consider, C0010294:Creatinine, C4321396:MG, C0750572:Estimated, C0016107:filtration, C1521828:Rate, C3842588:30%, C0439526:/mL, C0032821:Potassium, C0439152:mEq, C0015945:Fetal Monitoring, C0700205:Function Axis, C0012798:Diuretics, C0884358:Performed, C1704686:Initiation, C0332283:Followed by, C4697860:Not Followed, C0559897:Diet followed, C0035647:Risk, C0020461:Hyperkalemia, C0231179:Insufficiency, C0522271:Aldosterone receptor site, C0081880:Natriuretic Peptide, C-Type, C0439269:mg/dL, C0232809:Glomerular filtration, C0439445:mL/min, C0439402:mL/min/kg, C1641597:mL/min/SA, C1301862:Min 1, C0232804:Renal function, C4544334:History of renal insufficiency, C1446047:Plasma B natriuretic peptide measurement, C0017654:Glomerular Filtration Rate |
| 32564 | Aldosterone receptor antagonists are recommended to reduce morbidity and mortality following an acute MI in patients who have LVEF of ?40% who develop symptoms of Heart Failure or who have a history of diabetes mellitus, unless contraindicated. | C0262926:"Medical History", C0011849:"Diabetes Mellitus", C0597357:"receptor", C0002007:"Aldosterone Antagonists", C0002006:"Aldosterone", C1457887:"Symptoms" | C0002006:Aldosterone, C0597357:receptor, C0243076:antagonists, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality, C0332282:Following, C0205178:acute, C0030705:Patients, C0439509:/40, C3842587:40%, C1457887:Symptoms, C0019664:History, C0011847:Diabetes, C1444657:Contraindicated, C0522271:Aldosterone receptor site, C0455678:No family history diabetes, C0011849:Diabetes Mellitus, C0455488:H/O: diabetes mellitus, C1313937:Family history of diabetes mellitus, C3874269:Maternal history of diabetes mellitus, C3532488:History of diabetes mellitus type 2, C3532489:History of diabetes mellitus type 1 |
| 32565 | Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is >2.5 mg/dL in men or >2.0 mg/dL in women (or estimated glomerular filtration rate <30 mL/min/1.73 m2), and/or potassium >5.0 mEq/L. | C0010294:"Creatinine", C0017654:"Glomerular Filtration Rate", C0229671:"Serum", C0035078:"Kidney Failure", C0201976:"Creatinine measurement, serum (procedure)", C0020461:"Hyperkalemia", C0597357:"receptor", C0002007:"Aldosterone Antagonists", C0032821:"Potassium", C0002006:"Aldosterone" | C1548788:Inappropriate, C0002006:Aldosterone, C0597357:receptor, C0243076:antagonists, C0376558:Life, C2128835:verbal threatening, C2826244:Life Threatening, C0020461:Hyperkalemia, C0231179:Insufficiency, C0229671:Serum, C0010294:Creatinine, C4321396:MG, C0750572:Estimated, C0016107:filtration, C1521828:Rate, C3842588:30%, C0439526:/mL, C0032821:Potassium, C0439152:mEq, C0522271:Aldosterone receptor site, C2711184:Life threatening severity, C4544334:History of renal insufficiency, C0428282:Serum creatinine low, C0438243:Serum creatinine abnormal, C0438244:Serum creatinine normal, C0600061:Serum creatinine level, C0700225:Serum creatinine raised, C0439269:mg/dL, C0232809:Glomerular filtration, C0439445:mL/min, C0439402:mL/min/kg, C1641597:mL/min/SA, C1301862:Min 1, C0017654:Glomerular Filtration Rate |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0022251:"Isosorbide", C0022252:"Isosorbide Dinitrate", C0020223:"Hydralazine", C0087111:"Therapeutic procedure" | C0013162:Drug Combinations, C0052142:AP combination, C0054603:CAP combination, C0020223:Hydralazine, C0022251:Isosorbide, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality, C0030705:Patients, C0003988:Asian Americans, C0010436:Cuban Americans, C0456387:Class, C0003827:Art Therapy, C0243077:inhibitors, C1444657:Contraindicated, C0022252:Isosorbide Dinitrate |
| 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. | C0277585:"Drug intolerance", C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0022251:"Isosorbide", C0020649:"Hypotension", C0035078:"Kidney Failure", C0022252:"Isosorbide Dinitrate", C0020223:"Hydralazine", C0013227:"Pharmaceutical Preparations" | C0013162:Drug Combinations, C0052142:AP combination, C0054603:CAP combination, C0020223:Hydralazine, C0022251:Isosorbide, C3827682:Useful, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0008083:Child Mortality, C0030705:Patients, C0231220:Symptomatic, C1442162:GIVEN, C1999216:Inhibitor, C0009269:Cold intolerance, C0020649:Hypotension, C0231179:Insufficiency, C1444657:Contraindicated, C0022252:Isosorbide Dinitrate, C0277585:Intolerance to drug, C4544334:History of renal insufficiency |
| 32568 | Digoxin can be beneficial in patients with Heart FailurerEF, unless contraindicated, to decrease hospitalizations for Heart Failure. | C0012265:"Digoxin" | C0012265:Digoxin, C0030705:Patients, C1444657:Contraindicated, C0547047:Decrease, C0019993:Hospitalization, C4086639:Number of Hospitalizations |
| 32569 | Patients with chronic Heart Failure with permanent/persistent/paroxysmal AF and an additional risk factor for cardioembolic stroke (history of hypertension, diabetes mellitus, previous stroke or transient ischemic attack, or ?75 years of age) should receive chronic anticoagulant therapy (in the absence of contraindications to anticoagulation). | C0262926:"Medical History", C0038454:"Cerebrovascular accident", C0020538:"Hypertensive disease", C1304680:"Observation of attack", C1531624:"Cardioembolic stroke", C0011849:"Diabetes Mellitus", C0003280:"Anticoagulants", C0007787:"Transient Ischemic Attack", C0087111:"Therapeutic procedure", C0150457:"Anticoagulant therapy" | C0030705:Patients, C0205191:chronic, C0205355:Permanent, C0205322:Persistent, C0205311:Paroxysmal, C1524062:Additional, C0035647:Risk, C1521761:Factor, C1531624:Cardioembolic stroke, C0038819:Sunstroke, C0019664:History, C1963138:Hypertension, CTCAE, C2748577:No hypertension, C0020541:Portal Hypertension, C0011847:Diabetes, C0205156:Previous, C0475224:Ischemic, C4319621:75, C0439234:year, C3840862:75+ years, C3843647:> 2 years, C0001779:Age, C1514756:Receive, C0003280:Anticoagulants, C3536711:Anti-coagulant [EPC], C0150457:Anticoagulant therapy, C0003827:Art Therapy, C1301624:Medical contraindication, C0079164:contraindications aspect, C0683526:treatment contraindications, C0852649:Contraindications, Surgery, C1317264:Contraindications section, C3173979:Contraindications for test, C4505286:Contraindications, Drug, C4505287:Contraindications, Procedure, C0003281:Anticoagulation Therapy, C2919015:ANTICOAGULATION (finding), C0449867:Use of anticoagulation, C0694554:chronic anticoagulation, C1531589:Anticoagulation declined, C0035648:risk factors, C4038583:History of portal hypertension, C0011849:Diabetes Mellitus, C0007787:Transient Ischemic Attack, C0155530:Transient ischemic deafness, C0341425:Transient ischemic colitis, C1998164:History of cardioembolic stroke, C1446238:Stroke / transient ischemic attack referral, C1532938:Stroke/transient ischemic attack monitoring status |
| 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. | C0525032:"International Normalized Ratio", C0450442:"Agent", C1874451:"Basis", C0449210:"OTH tumor staging notation", C0003280:"Anticoagulants", C0043031:"Warfarin", C1831808:"apixaban", C1739768:"rivaroxaban", C0013227:"Pharmaceutical Preparations" | C0005999:Book Selection, C0016488:Food Selection, C0024909:Mate Selection, C0036577:Selection Bias, C0003280:Anticoagulants, C3536711:Anti-coagulant [EPC], C0150457:Anticoagulant therapy, C0450442:Agent, C0043031:Warfarin, C2348066:dabigatran, C1831808:apixaban, C1739768:rivaroxaban, C0205355:Permanent, C0205322:Persistent, C0205311:Paroxysmal, C1881197:Individualized, C1874451:Basis, C0035647:Risk, C0000779:ABO Factors, C0001783:Age Factors, C3274448:Tolerability Study, C0030705:Patients, C0558295:preference, C3245505:Potential, C0687133:Drug Interactions, C0242784:Food Interactions, C0205394:Other, C0205210:Clinical, C1521970:Characteristics, C0040223:Time, C1512888:International, C1882115:Normalize, C2986790:Normalized Time, C0456603:Ratio, C0302350:Therapeutic, C1514721:Range, C0455939:A/N risk factors, C0525032:International Normalized Ratio, C1272307:Target international normalized ratio, C0460092:Therapeutic range comments, C0460096:Above therapeutic range, C0460097:Within therapeutic range, C0460099:Below therapeutic range, C0332310:Has patient |
| 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). | C0038454:"Cerebrovascular accident", C1531624:"Cardioembolic stroke" | C0205191:chronic, C0003281:Anticoagulation Therapy, C2919015:ANTICOAGULATION (finding), C0449867:Use of anticoagulation, C0694554:chronic anticoagulation, C1531589:Anticoagulation declined, C0030705:Patients, C0205355:Permanent, C0205322:Persistent, C0205311:Paroxysmal, C0332288:Without, C1524062:Additional, C0035647:Risk, C1521761:Factor, C1531624:Cardioembolic stroke, C0038819:Sunstroke, C1301624:Medical contraindication, C0079164:contraindications aspect, C0683526:treatment contraindications, C0852649:Contraindications, Surgery, C1317264:Contraindications section, C3173979:Contraindications for test, C4505286:Contraindications, Drug, C4505287:Contraindications, Procedure, C0035648:risk factors |
| 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) | C0449416:"Source" | C0003281:Anticoagulation Therapy, C2919015:ANTICOAGULATION (finding), C0449867:Use of anticoagulation, C0694554:chronic anticoagulation, C1531589:Anticoagulation declined, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C0205191:chronic, C0332288:Without, C0333214:thromboembolic, C0441471:Event, C1531624:Cardioembolic stroke, C0449416:Source, C0814225:Benefit, C1531590:Anticoagulation not indicated, C1531591:Anticoagulation not tolerated, C3839946:Anticoagulation clinic |
| 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. | C1689985:"Absence (morphologic abnormality)", C0449210:"OTH tumor staging notation", C0011900:"Diagnosis", C0360714:"Hydroxymethylglutaryl-CoA Reductase Inhibitors", C0087111:"Therapeutic procedure" | C1292783:Adjunctive care, C0003827:Art Therapy, C0278329:Prescribed, C0011900:Diagnosis, C0205394:Other, C0521090:No indication of, C2019909:stent indications, C2093656:PTCA indications: |
| 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. | C0032615:"Polyunsaturated Fatty Acids", C0015684:"Fatty Acids", C0015689:"Omega-3 Fatty Acids", C0087111:"Therapeutic procedure", C0001128:"Acids", C1457887:"Symptoms" | C1719844:Omega, C1720954:Polyunsaturated Alkamides, C2362518:Polyunsaturated fat, C0001128:Acids, C0242297:Dietary Supplementation, C0242296:Food Supplementation, C0302837:Vitamin supplementation, C0556077:Energy supplementation, C0556086:Nitrogen supplementation, C0556088:Fat supplementation, C0556089:Choline supplementation, C1292783:Adjunctive care, C0003827:Art Therapy, C0030705:Patients, C0456387:Class, C1457887:Symptoms, C1444657:Contraindicated, C0008083:Child Mortality, C0007226:Cardiovascular system, C3887460:Cardiovascular, C0019993:Hospitalization, C4086639:Number of Hospitalizations, C0032615:Polyunsaturated Fatty Acids, C0556123:Polyunsaturated fatty acid intake, C0452290:High polyunsaturated fatty acid diet, C0015684:Fatty Acids, C0452291:High n-3 polyunsaturated fatty acid diet, C0556056:Polyunsaturated fatty acid requirement, C0556095:Polyunsaturated fatty acid supplementation, C0452293:High n-6 polyunsaturated fatty acid diet |
| 32575 | Nutritional supplements as treatment for Heart Failure are NOT recommended in patients with current or prior symptoms of Heart FailurerEF. | C1457887:"Symptoms" | C1521739:Nutritional, C0351437:oral supplement, C0721124:Iron Supplement, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C1457887:Symptoms |
| 32576 | Hormonal therapies other than to correct deficiencies are NOT recommended for patients with current or prior symptoms of Heart FailurerEF. | C1457887:"Symptoms" | C0458083:Hormonal, C0205394:Other, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C1457887:Symptoms |
| 32577 | Drugs known to adversely affect the clinical status of patients with current or prior symptoms of Heart FailurerEF are potentially harmful and should be avoided or withdrawn whenever possible (eg, most antiarrhythmic drugs, most calcium channel–blocking drugs [except amlodipine], nonsteroidal anti-inflammatory drugs, or thiazolidinediones). | C0051696:"Amlodipine", C1257987:"Thiazolidinediones", C0003195:"Anti-Arrhythmia Agents", C0006675:"Calcium", C0013227:"Pharmaceutical Preparations", C1457887:"Symptoms" | C0205309:Known, C0205210:Clinical, C0449438:Status, C0030705:Patients, C1457887:Symptoms, C0424092:Withdrawn, C0332149:Possible, C0205393:Most, C3537142:Antiarrhythmic [EPC], C0051989:antiarrhythmic peptide, C0006675:Calcium, C0439799:Channel, C0332206:Blocking, C0332300:Except for, C0051696:Amlodipine, C0333348:Inflammatory, C1257987:Thiazolidinediones, C0449440:Clinical status, C1153433:calcium channel activity, C0006684:Calcium Channel Blockers |
| 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). | C0354668:"Positive inotropic drug", C0013227:"Pharmaceutical Preparations", C0012634:"Disease" | C0205166:Long, C1446409:Positive, C0304509:Inotropic agent, C0030705:Patients, C0332300:Except for, C0444930:End, C1306673:Stage, C0012634:Disease, C0205476:Medical, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C1947903:See, C0034866:Recommendation, C1545264:Diagnosis recommendations, C3266698:Recommendations refused, C0205088:End-stage, C0849833:Fear of medical treatment, C0745744:End Stage Liver Disease |
| 32579 | Calcium channel–blocking drugs are NOT recommended as routine treatment for patients with Heart FailurerEF. | C0006675:"Calcium", C0013227:"Pharmaceutical Preparations" | C0006675:Calcium, C0439799:Channel, C0332206:Blocking, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0205547:Routine, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C0030705:Patients, C1153433:calcium channel activity, C0006684:Calcium Channel Blockers |
| 32580 | Systolic and diastolic blood pressure should be controlled in patients with Heart FailurepEF in accordance with published clinical practice guidelines to prevent morbidity. | C0460139:"Pressure (finding)", C1272641:"Systemic arterial pressure", C0005767:"Blood" | C0039155:Systole, C0442710:Peak systolic, C0489485:end systolic, C0012000:Diastole, C0442709:end diastolic, C0005767:Blood, C1882095:No Pressure, C0001876:Air Pressure, C0205318:Uncontrolled, C0332298:Controlled by, C0030705:Patients, C0205210:Clinical, C0162791:Guidelines, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0428883:Diastolic blood pressure, C0005823:Blood Pressure, C0445199:Pressure controlled method, C0564626:Pressure controlled ventilation, C0564627:Pressure controlled SIMV |
| 32581 | Diuretics should be used for relief of symptoms due to volume overload in patients with Heart FailurepEF. | C0012798:"Diuretics", C0564405:"Feeling relief", C1457887:"Symptoms" | C0012798:Diuretics, C1457887:Symptoms, C3146286:Due, C0449468:Volume, C0282193:Iron Overload, C0342947:Salt overload, C0030705:Patients, C4720856:Cardiac volume overload |
| 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:"Ischemia", C0002962:"Angina Pectoris", C0151744:"Myocardial Ischemia", C0581603:"Revascularization - action", C1457887:"Symptoms" | C1522318:Coronary, C0581603:Revascularization - action, C0007794:Cerebral Revascularization, C0027056:Myocardial Revascularization, C0472662:Limb revascularization, C0472665:Revascularization of forearm, C0472666:Revascularization of hand, C0472667:Revascularization of thumb, C0472668:Revascularization of finger, C0472672:Revascularization of foot, C0030705:Patients, C1457887:Symptoms, C0332265:Demonstrable, C0027061:Myocardium, C1522564:Myocardial, C0022116:Ischemia, C4534514:Having sex, C1280500:Effect, C0231220:Symptomatic, C0151744:Myocardial Ischemia |
| 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. | C0003015:"Angiotensin-Converting Enzyme Inhibitors", C0020538:"Hypertensive disease", C0460139:"Pressure (finding)", C1272641:"Systemic arterial pressure", C0450442:"Agent", C0005767:"Blood" | C0332206:Blocking, C0243077:inhibitors, C0030705:Patients, C1963138:Hypertension, CTCAE, C2748577:No hypertension, C0020541:Portal Hypertension, C0005767:Blood, C1882095:No Pressure, C0001876:Air Pressure, C0005823:Blood Pressure, C0419171:Conscious blood pressure control |
| 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. | C0010294:"Creatinine", C2946261:"Level", C0017654:"Glomerular Filtration Rate", C0597357:"receptor", C0002007:"Aldosterone Antagonists", C0032821:"Potassium", C0002006:"Aldosterone" | C4717986:Dresses appropriately, C0030705:Patients, C3163633:Elevated, C0457453:On admission, C4533677:at admission, C0559269:Pre-admission, C0332285:Within, C0439234:year, C0750572:Estimated, C0016107:filtration, C1521828:Rate, C3842588:30%, C0439526:/mL, C0010294:Creatinine, C4321396:MG, C0032821:Potassium, C0439152:mEq, C0002006:Aldosterone, C0597357:receptor, C0243076:antagonists, C0750591:consider, C0547047:Decrease, C0019993:Hospitalization, C4086639:Number of Hospitalizations, C0232809:Glomerular filtration, C0439445:mL/min, C0439402:mL/min/kg, C1641597:mL/min/SA, C0439269:mg/dL, C0522271:Aldosterone receptor site, C0017654:Glomerular Filtration Rate |
| 32587 | Routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QoL in patients with Heart FailurepEF is ineffective. | C0028125:"Nitrates" | C0205547:Routine, C0028125:Nitrates, C1753334:phosphodiesterase activity, C0031638:Phosphodiesterase Inhibitors, C0045231:2'-phosphodiesterase, C0070828:Phosphodiesterase I, C0243077:inhibitors, C0442805:Increase, C3845261:No activity, C0030705:Patients, C3242229:ineffective, C1318700:Phosphodiesterase 5 inhibitor |
| 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) | C0085298:"Sudden Cardiac Death", C0018799:"Heart Diseases", C0018787:"Heart", C0033144:"Primary Prevention", C0011071:"Sudden death", C1306577:"Death (finding)", C0151744:"Myocardial Ischemia", C1281570:"Entire heart", C1457887:"Symptoms", C0439631:"Primary operation", C0199176:"Prophylactic treatment", C0087111:"Therapeutic procedure", C0012634:"Disease" | C0003827:Art Therapy, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0205225:Primary, C1706420:Prevention Study, C0150223:Fall prevention, C0439810:Total, C0008083:Child Mortality, C0030705:Patients, C0475224:Ischemic, C0018787:Heart, C0012634:Disease, C0439509:/40, C3842587:40%, C0439228:day, C0687676:Post, C4319605:35, C0456387:Class, C1457887:Symptoms, C0205191:chronic, C0679138:Expectations, C0679142:Role Expectations, C0946217:Meaningful life, C3494324:Meaningful Use, C0007620:Cell Survival, C0038954:Survival Rate, C0439234:year, C0033144:Primary Prevention, C0085298:Sudden Cardiac Death, C0018799:Heart Diseases, C0475676:No FH: Ischemic heart disease, C0740220:Ischemic heart disease screen, C0848343:Subacute ischemic heart disease, C1510446:Acute ischemic heart disease |
| 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. | C0225917:"Entire left bundle branch", C0016169:"pathologic fistula", C0028778:"Obstruction", C0423772:"Cutaneous Fistula", C0023211:"Left Bundle-Branch Block", C0006384:"Bundle-Branch Block", C0232201:"Sinus rhythm", C0087111:"Therapeutic procedure", C2926735:"Duration", C1457887:"Symptoms" | C0003827:Art Therapy, C1444656:Indicated, C0030705:Patients, C4319605:35, C0871269:Rhythm, C0205091:Left, C1253959:Branch of, C2926735:Duration, C1704243:Greater, C0456387:Class, C1457887:Symptoms, C0232201:Sinus rhythm, C0006384:Bundle-Branch Block, C0023211:Left Bundle-Branch Block, C0155702:Left bundle branch hemiblock, C0225917:Entire left bundle branch, C0459156:Left bundle branch structure, C0085615:Right bundle branch block, C0264916:Bilateral bundle branch block, C0264915:Left main stem bundle branch block, C0281878:Incomplete left bundle branch block, C4518442:ECG complete left bundle branch block |
| 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. | C0033144:"Primary Prevention", C0439631:"Primary operation", C0199176:"Prophylactic treatment", C0087111:"Therapeutic procedure", C1457887:"Symptoms" | C0003827:Art Therapy, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0205225:Primary, C1706420:Prevention Study, C0150223:Fall prevention, C0439810:Total, C0008083:Child Mortality, C0030705:Patients, C0439509:/40, C3842587:40%, C0439228:day, C0687676:Post, C3842588:30%, C0456387:Class, C1457887:Symptoms, C0750519:while, C0679138:Expectations, C0679142:Role Expectations, C0946217:Meaningful life, C3494324:Meaningful Use, C0007620:Cell Survival, C0038954:Survival Rate, C0205172:More, C0439234:year, C0033144:Primary Prevention |
| 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. | C0016169:"pathologic fistula", C0423772:"Cutaneous Fistula", C0232201:"Sinus rhythm", C2926735:"Duration", C1457887:"Symptoms" | C3827682:Useful, C0030705:Patients, C4319605:35, C0871269:Rhythm, C0449774:Patterns, C4699190:A pattern, C2926735:Duration, C0456387:Class, C1457887:Symptoms, C0232201:Sinus rhythm |
| 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. | C0016169:"pathologic fistula", C0423772:"Cutaneous Fistula", C0232201:"Sinus rhythm", C2926735:"Duration", C1457887:"Symptoms" | C3827682:Useful, C0030705:Patients, C4319605:35, C0871269:Rhythm, C2926735:Duration, C4319550:120, C0456387:Class, C1457887:Symptoms, C0232201:Sinus rhythm |
| 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. | C0547070:"Ablation", C0308718:"CONTROL veterinary product" | C3827682:Useful, C0030705:Patients, C4319605:35, C1553395:Requires crib, C1522565:Ventricular, C3272404:No Pacing, C0243161:criteria, C0004245:Atrioventricular Block, C0225924:Atrioventricular valve, C0547070:Ablation, C0031330:Pharmacology, C0205464:pharmacological, C1521828:Rate, C1706276:Near, C3817553:100%, C0429115:Ventricular pacing pattern, C0428912:Atrioventricular nodal function |
| 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. | C1533810:"Placement action", C0441587:"Clinical act of insertion", C0035139:"Surgical Replantation", C0021107:"Implantation procedure" | C3827682:Useful, C0030705:Patients, C4319605:35, C1524072:Placement, C0205314:New, C0559956:Replacement, C0699733:Devices, C3840775:Anticipated, C1514873:Requirement, C0750502:Significant, C0439509:/40, C3842587:40%, C1522565:Ventricular, C3272404:No Pacing, C1446530:Replacement of device, C0429115:Ventricular pacing pattern |
| 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. | C0424594:"Frailty", C1306459:"Primary malignant neoplasm", C0021107:"Implantation procedure", C1306577:"Death (finding)" | C4721826:Implantation - action, C0005698:Blade Implantation, C0087130:Uncertainty, C0426068:Uncertain lie, C0747001:ONSET UNCERTAIN, C1519761:Uncertain Risk, C0814225:Benefit, C0946217:Meaningful life, C3494324:Meaningful Use, C0007620:Cell Survival, C0038954:Survival Rate, C0030705:Patients, C0205250:High, C0035647:Risk, C0332183:Frequently, C0019993:Hospitalization, C4086639:Number of Hospitalizations, C0424594:Frailty, C0009488:Comorbidity, C0205373:Systemic, C3842363:No malignancy, C4316743:Not severe, C3887504:Dysfunction, C0332167:High risk of, C4319571:High risk, C0456040:Newborn renal dysfunction |
| 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. | C0016169:"pathologic fistula", C0423772:"Cutaneous Fistula", C0232201:"Sinus rhythm", C2926735:"Duration" | C0750591:consider, C0030705:Patients, C4319605:35, C0871269:Rhythm, C0449774:Patterns, C4699190:A pattern, C2926735:Duration, C4319550:120, C0456387:Class, C0232201:Sinus rhythm |
| 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. | C0016169:"pathologic fistula", C0423772:"Cutaneous Fistula", C0232201:"Sinus rhythm", C1457887:"Symptoms", C2926735:"Duration" | C0750591:consider, C0030705:Patients, C4319605:35, C0871269:Rhythm, C0449774:Patterns, C4699190:A pattern, C2926735:Duration, C0456387:Class, C1457887:Symptoms, C0232201:Sinus rhythm |
| 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. | C0016169:"pathologic fistula", C0423772:"Cutaneous Fistula", C0232201:"Sinus rhythm", C2926735:"Duration", C1457887:"Symptoms" | C0750591:consider, C0030705:Patients, C3842588:30%, C0475224:Ischemic, C1314792:Etiology, C0871269:Rhythm, C2926735:Duration, C0456387:Class, C1457887:Symptoms, C0232201:Sinus rhythm |
| 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. | C2926735:"Duration", C1457887:"Symptoms" | C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0030705:Patients, C0456387:Class, C1457887:Symptoms, C0449774:Patterns, C4699190:A pattern, C2926735:Duration |
| 32601 | CRT is NOT indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to <1 year. | C1998319:"Functional capacity", C0424594:"Frailty" | C1444656:Indicated, C0030705:Patients, C0009488:Comorbidity, C0424594:Frailty, C0007620:Cell Survival, C0038954:Survival Rate, C0205170:Good, C0205245:Functional, C1516240:Capacity, C0439234:year, C1444655:Not indicated, C1998319:Functional capacity |
| 32602 | Fluid restriction (1.5–2 L/d) is reasonable in stage D, especially in patients with hyponatremia, to reduce congestive symptoms. | C0020625:"Hyponatremia", C0204700:"Fluid restriction", C1457887:"Symptoms" | C0150136:Area restriction, C0204700:Fluid restriction, C0849760:chest restriction, C1306673:Stage, C0030705:Patients, C0020625:Hyponatremia, C0742742:Congestive, C1457887:Symptoms |
| 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. | C0018823:"Heart Transplantation", C0036980:"Shock, Cardiogenic", C0040732:"Transplantation", C0018787:"Heart", C0183683:"Support, device", C0033213:"Problem", C0031001:"Perfusion (procedure)", C0344211:"Supportive care", C0036974:"Shock", C0581603:"Revascularization - action", C0087111:"Therapeutic procedure", C1281570:"Entire heart" | C1720302:Until, C0443196:Definitive, C0003827:Art Therapy, C1522318:Coronary, C0581603:Revascularization - action, C0007794:Cerebral Revascularization, C0027056:Myocardial Revascularization, C0472662:Limb revascularization, C0472665:Revascularization of forearm, C0472666:Revascularization of hand, C0472667:Revascularization of thumb, C0472668:Revascularization of finger, C0472672:Revascularization of foot, C0018787:Heart, C0040732:Transplantation, C2699488:Resolution, C0205178:acute, C0032930:Precipitating Factors, C0033213:Problem, C0030705:Patients, C0036980:Shock, Cardiogenic, C4242108:Cardiogenic area, C4325538:Cardiogenic cough, C0036974:Shock, C1514756:Receive, C0348016:Intravenous, C0304509:Inotropic agent, C0205373:Systemic, C4281794:Perfusion route, C0029704:Other perfusion, C0597198:Performance, C0018823:Heart Transplantation |
| 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. | C0040732:"Transplantation", C0183683:"Support, device", C0456378:"Type of bridge device", C0344211:"Supportive care", C0087111:"Therapeutic procedure" | C0549178:Continuous, C0348016:Intravenous, C0304509:Inotropic agent, C0003827:Art Therapy, C0030705:Patients, C1306673:Stage, C0349412:Refractory shock, C0699733:Devices, C1548635:Eligible, C0040732:Transplantation |
| 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. | C0460139:"Pressure (finding)", C0020649:"Hypotension", C1272641:"Systemic arterial pressure", C0183683:"Support, device", C0344315:"Depressed mood", C0031001:"Perfusion (procedure)", C0344211:"Supportive care", C0749225:"Systolic dysfunction", C0005767:"Blood" | C1806781:Short, C0549178:Continuous, C0348016:Intravenous, C0304509:Inotropic agent, C0008098:Child, Hospitalized, C0749199:SYNCOPE HOSPITALIZED, C1546950:Caused hospitalized, C0030705:Patients, C0426109:Caput presenting, C1301725:Documented, C4316743:Not severe, C0039155:Systole, C0442710:Peak systolic, C0489485:end systolic, C3887504:Dysfunction, C0150312:Present, C0205251:low, C0005767:Blood, C1882095:No Pressure, C0001876:Air Pressure, C4055637:Significantly high, C4055638:Significantly low, C0437472:O/E - significantly deaf, C0344315:Depressed mood, C0436599:O/E - depressed, C0205373:Systemic, C4281794:Perfusion route, C0029704:Other perfusion, C0444930:End, C0178784:Organ, C0597198:Performance, C0749225:Systolic dysfunction, C0005823:Blood Pressure, C0007165:Cardiac Output, C0476454:Low blood pressure reading |
| 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. | C1274136:"Symptom control (regime/therapy)", C0040732:"Transplantation", C0183683:"Support, device", C0344211:"Supportive care", C0087111:"Therapeutic procedure", C1457887:"Symptoms", C0308718:"CONTROL veterinary product" | C0205166:Long, C0549178:Continuous, C0348016:Intravenous, C0304509:Inotropic agent, C0750591:consider, C1285530:Palliative, C0003827:Art Therapy, C1457887:Symptoms, C1651012:Select-OB, C2730299:PNV Select, C0030705:Patients, C1306673:Stage, C0699733:Devices, C1548635:Eligible, C3844638:Either, C0040732:Transplantation, C0518680:Symptom control behavior, C0020587:Hypnotherapy, C1274136:Symptom control (regime/therapy) |
| 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:"Palliative Care", C0450442:"Agent", C1689985:"Absence (morphologic abnormality)", C0304509:"Inotropic agent" | C0205166:Long, C3844638:Either, C0549178:Continuous, C0205267:Intermittent, C0348016:Intravenous, C1446409:Positive, C0304509:Inotropic agent, C0521090:No indication of, C2019909:stent indications, C2093656:PTCA indications:, C0205394:Other, C1285530:Palliative, C0030705:Patients, C4273874:Intermittent intravenous infusion of iron, C0030231:Palliative Care |
| 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. | C0460139:"Pressure (finding)", C0020649:"Hypotension", C0700148:"Congestion", C1272641:"Systemic arterial pressure", C0344315:"Depressed mood", C0450442:"Agent", C0031001:"Perfusion (procedure)", C0304509:"Inotropic agent", C0749225:"Systolic dysfunction", C0005767:"Blood" | C0304509:Inotropic agent, C0008098:Child, Hospitalized, C0749199:SYNCOPE HOSPITALIZED, C1546950:Caused hospitalized, C0030705:Patients, C0332288:Without, C1301725:Documented, C4316743:Not severe, C0039155:Systole, C0442710:Peak systolic, C0489485:end systolic, C3887504:Dysfunction, C0205251:low, C0005767:Blood, C1882095:No Pressure, C0001876:Air Pressure, C0221099:Impaired, C4281794:Perfusion route, C0029704:Other perfusion, C3887511:Evidence, C4055637:Significantly high, C4055638:Significantly low, C0437472:O/E - significantly deaf, C0344315:Depressed mood, C0436599:O/E - depressed, C0700148:Congestion, C0749225:Systolic dysfunction, C0005823:Blood Pressure, C0007165:Cardiac Output, C0476454:Low blood pressure reading |
| 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. | C0040732:"Transplantation" | C0030705:Patients, C1306673:Stage, C0443196:Definitive, C0002766:Pain management, C0040732:Transplantation, C3840775:Anticipated, C1301732:Planned |
| 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. | C0456378:"Type of bridge device" | C0522523:Percutaneous, C0442087:Extracorporeal, C1522565:Ventricular, C0699733:Devices, C0679006:Decision, C0030705:Patients, C0205178:acute, C0439808:Profound, C0019010:Hemodynamics, C0489837:Hemodynamic method, C0919772:Hemodynamic test, C2945640:compromise, C0181598:Left ventricular assist device |
| 32612 | Evaluation for cardiac transplantation is indicated for carefully selected patients with stage D Heart Failure despite GDMT, device, and surgical management. | C0543467:"Operative Surgical Procedures", C0040732:"Transplantation", C1261322:"Evaluation procedure" | C0220825:Evaluation, C0040732:Transplantation, C1444656:Indicated, C0030705:Patients, C1306673:Stage, C0699733:Devices, C0002766:Pain management |
| 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. | C1623258:"Electrocardiography", C0229671:"Serum", C0041199:"Troponin", C0033325:"Forecast of outcome", C0231187:"Decompensation" | C0032930:Precipitating Factors, C0205178:acute, C0231187:Decompensation, C0205396:Identified, C0229671:Serum, C0041366:Biomarkers, Tumor, C0041199:Troponin, C0039593:Testing, C1548787:Appropriate, C1561607:Overall, C0348080:Condition, C0278250:Prognosis good, C0278251:Fair prognosis, C0278252:Prognosis bad, C0030705:Patients, C1305957:Cardiac troponin I |
| 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. | C1261322:"Evaluation procedure", C0087111:"Therapeutic procedure" | C0032930:Precipitating Factors, C0000779:ABO Factors, C0001783:Age Factors, C0205178:acute, C0750591:consider, C0347984:During, C0205265:Initially, C0220825:Evaluation, C0233798:False recognition, C0518821:Recognition of urge, C0589518:Route recognition, C0597498:speech recognition, C0599621:Object Recognition, C0678836:cell recognition, C1511545:Critical, C1548787:Appropriate, C0003827:Art Therapy |
| 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. | C0948268:"Hemodynamic instability", C1444783:"Instability" | C0030705:Patients, C0231220:Symptomatic, C4086268:Exacerbation, C0019993:Hospitalization, C0347984:During, C0205191:chronic, C0024501:Maintenance, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C0019010:Hemodynamics, C0489837:Hemodynamic method, C0919772:Hemodynamic test, C1444783:Instability, C1301624:Medical contraindication, C0079164:contraindications aspect, C0683526:treatment contraindications, C0852649:Contraindications, Surgery, C1317264:Contraindications section, C3173979:Contraindications for test, C4505286:Contraindications, Drug, C4505287:Contraindications, Procedure, C0948268:Hemodynamic instability |
| 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. | C0457454:"Discontinuation (procedure)", C0028778:"Obstruction", C0042402:"Vasodilator Agents", C0450442:"Agent", C0304509:"Inotropic agent", C0087111:"Therapeutic procedure", C0012798:"Diuretics" | C1704686:Initiation, C0003827:Art Therapy, C3846195:Not Recommended, C1820977:Recommended diet, C3839514:Change recommended, C3846199:Chem recommended, C2698650:Optimization, C0449468:Volume, C0449438:Status, C0597535:Success, C1272703:Successful, C0457454:Discontinuation (procedure), C2026123:central IV discontinuation, C0348016:Intravenous, C0012798:Diuretics, C2010769:general vasodilators, C0304509:Inotropic agent, C0205251:low, C0038371:Stable Fly, C0030705:Patients, C0445550:Low dose, C1278478:Beta blocker therapy refused |
| 32618 | Patients with Heart Failure admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to reduce morbidity. | C0546817:"Fluid overload", C0354100:"Loop Diuretics", C0012798:"Diuretics" | C0030705:Patients, C4482331:Admitted to, C2599640:Admitted from, C3887511:Evidence, C0750502:Significant, C0282193:Iron Overload, C0342947:Salt overload, C0348016:Intravenous, C0445022:Loop, C0012798:Diuretics, C0009488:Comorbidity, C0178685:human morbidity, C0580966:Morbidity index, C0546817:Fluid overload |
| 32619 | If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose | C0354100:"Loop Diuretics", C0012798:"Diuretics", C0087111:"Therapeutic procedure" | C0030705:Patients, C0445022:Loop, C0012798:Diuretics, C0003827:Art Therapy, C0205265:Initially, C0348016:Intravenous, C0205163:Equal, C0205191:chronic, C0442027:Oral, C0332173:Daily, C0354100:Loop Diuretics, C0948575:Diuretic therapy |
| 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. | C0010294:"Creatinine", C0041942:"Urea", C0229671:"Serum", C0700148:"Congestion", C0311392:"Physical findings", C1457887:"Symptoms", C1291218:"Carbonyldiamide", C0587355:"Electrolytes measurement, serum", C0028158:"Nitrogen", C0031001:"Perfusion (procedure)", C0012798:"Diuretics", C0013227:"Pharmaceutical Preparations", C0013832:"Electrolytes" | C1280500:Effect, C3161471:Treatment Study, C3538994:Treatment Epoch, C0746919:NO TREATMENT, C0242485:Measurement, C1512806:Intake, C0043100:Weight, C0521095:Determined by, C0521096:Not determined by, C0445247:Same, C0040223:Time, C0439228:day, C0205210:Clinical, C1457887:Symptoms, C0205373:Systemic, C4281794:Perfusion route, C0029704:Other perfusion, C0700148:Congestion, C0332173:Daily, C0229671:Serum, C0013832:Electrolytes, C0041942:Urea, C0028158:Nitrogen, C0010294:Creatinine, C0086045:Mental concentration, C0428646:Oxygen concentration, C0678756:drug concentration, C0683149:serum concentration, C0444706:Measured, C0347984:During, C0348016:Intravenous, C0012798:Diuretics, C0205177:Active, C2983683:Titration Study, C4284232:Medications, C0427761:Body fluid pH measurement, C0429791:Fluid intake, C0005910:Body Weight, C0600137:Blood Urea Nitrogen, C3251814:Fluid Intake Measurement |
| 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). | C0354100:"Loop Diuretics", C0012798:"Diuretics", C1457887:"Symptoms" | C0012797:Diuresis, C1457887:Symptoms, C0012798:Diuretics, C1879523:AT Regimen, C0050372:ABP regimen, C3844638:Either, C0348016:Intravenous, C0445022:Loop, C0332287:In addition to, C0457385:seconds, C0565930:per second, C0541746:Thiazides |
| 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. | C0574032:"Infusion procedures", C0013030:"Dopamine", C0354100:"Loop Diuretics", C0012798:"Diuretics", C0087111:"Therapeutic procedure", C0005767:"Blood" | |
| 32623 | Ultrafiltration may be considered for patients with obvious volume overload to alleviate congestive symptoms and fluid weight. | C0041612:"Ultrafiltration (procedure)", C1274136:"Symptom control (regime/therapy)", C1457887:"Symptoms" | |
| 32624 | Ultrafiltration may be considered for patients with refractory congestion not responding to medical therapy. | C0041612:"Ultrafiltration (procedure)", C0700148:"Congestion", C0418981:"Medical therapy", C0087111:"Therapeutic procedure" | |
| 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. | C0001551:"Immunologic Adjuvants", C0017887:"Nitroglycerin", C0020649:"Hypotension", C0054015:"Nesiritide", C0012798:"Diuretics", C0087111:"Therapeutic procedure", C0564405:"Feeling relief", C0013404:"Dyspnea", C0028193:"Nitroprusside" | |
| 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. | C0040038:"Thromboembolism", C0199176:"Prophylactic treatment", C0003280:"Anticoagulants", C0013227:"Pharmaceutical Preparations" | |
| 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. | C0020625:"Hyponatremia", C0229671:"Serum", C0037473:"Sodium", C0523891:"Serum sodium measurement", C0043047:"Water", C0457423:"V2 stage", C0597357:"receptor", C1705480:"Vasopressin (USP)", C1457887:"Symptoms" | |
| 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 | C0020649:"Hypotension", C0085555:"Hospice Care", C1275743:"Co-morbid conditions", C0039401:"Educational process of instructing", C0678211:"Reinforcement surgical repair", C0587355:"Electrolytes measurement, serum", C1261322:"Evaluation procedure", C0183683:"Support, device", C0030231:"Palliative Care", C0013658:"Educational Status", C0600083:"Discharge, Body Substance, Sample", C0344211:"Supportive care", C0424927:"Details of education", C0589120:"Follow-up status", C0012621:"Body Fluid Discharge", C0013832:"Electrolytes", C0087111:"Therapeutic procedure" | |
| 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. | C2728259:"Program", C1303150:"Disease management program (regime/therapy)", C0012634:"Disease" | |
| 32631 | Scheduling an early follow-up visit (within 7–14 days) and early telephone follow-up (within 3 days) of hospital discharge is reasonable. | C0600083:"Discharge, Body Substance, Sample", C0589120:"Follow-up status", C0012621:"Body Fluid Discharge" | |
| 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. | C0240066:"Iron deficiency", C0302583:"Iron", C0392916:"Intracellular ferritin", C0332155:"Did not receive therapy or drug for", C0035139:"Surgical Replantation", C0162429:"Malnutrition", C0040679:"Transferrin", C0015879:"Ferritin", C1277709:"Transferrin saturation measurement" | |
| 32634 | In patients with Heart Failure and anemia, erythropoietin-stimulating agents should not be used to improve morbidity and mortality. | C0002871:"Anemia", C0450442:"Agent", C0014822:"Erythropoietin" | |
| 32635 | In patients at increased risk, stage A Heart Failure, the optimal blood pressure in those with hypertension should be <130/80 mm Hg. | C0020538:"Hypertensive disease", C0460139:"Pressure (finding)", C1272641:"Systemic arterial pressure", C0005767:"Blood" | |
| 32636 | Patients with Heart FailurerEF and hypertension should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg. | C0020538:"Hypertensive disease", C0460139:"Pressure (finding)", C1272641:"Systemic arterial pressure", C0005767:"Blood" | |
| 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 | C0020538:"Hypertensive disease", C0460139:"Pressure (finding)", C1272641:"Systemic arterial pressure", C0005767:"Blood" | |
| 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 | C0013144:"Drowsiness", C1261322:"Evaluation procedure", C0225386:"Breath", C0917799:"Hypersomnia" | |
| 32639 | In patients with cardiovascular disease and obstructive sleep apnea, CPAP may be reasonable to improve sleep quality and daytime sleepiness | C0013144:"Drowsiness", C0520679:"Sleep Apnea, Obstructive", C0007222:"Cardiovascular Diseases", C0037315:"Sleep Apnea Syndromes", C0003578:"Apnea", C0012634:"Disease" | |
| 32640 | In patients with NYHA class II–IV Heart FailurerEF and central sleep apnea, adaptive servo-ventilation causes harm | C0520680:"Sleep Apnea, Central", C0037315:"Sleep Apnea Syndromes", C0003578:"Apnea" | |
| 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:"Coronary Artery Bypass Surgery", C0440761:"Coronary artery graft (morphologic abnormality)", C1273869:"Intervention regimes", C0185098:"Bypass graft", C0205042:"Coronary artery", C0581603:"Revascularization - action", C0002962:"Angina Pectoris", C0009814:"Acquired stenosis", C0003842:"Arteries", C1261287:"Stenosis", C0332835:"Transplanted tissue", C0181074:"Graft material", C1269008:"Entire coronary artery", C0741847:"Bypass", C0947637:, C0012634:"Disease" | |
| 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:"Coronary Artery Bypass Surgery", C0440761:"Coronary artery graft (morphologic abnormality)", C0185098:"Bypass graft", C0205042:"Coronary artery", C0749225:"Systolic dysfunction", C0242231:"Coronary Stenosis", C0009814:"Acquired stenosis", C0581603:"Revascularization - action", C0003842:"Arteries", C1261287:"Stenosis", C0332835:"Transplanted tissue", C0181074:"Graft material", C1269008:"Entire coronary artery", C0741847:"Bypass", C0947637:, C0027061:"Myocardium" | |
| 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. | C0418981:"Medical therapy", C0087111:"Therapeutic procedure" | |
| 32644 | Surgical aortic valve replacement is reasonable for patients with critical aortic stenosis and a predicted surgical mortality of <10%. (IIa-B) | C1261287:"Stenosis", C0543467:"Operative Surgical Procedures", C0003483:"Aorta", C0003507:"Aortic Valve Stenosis", C0003506:"Replacement of aortic valve (procedure)", C0035139:"Surgical Replantation", C1269005:"Entire aortic valve", C0009814:"Acquired stenosis", C0003501:"Aortic valve structure", C0947637: | |
| 32645 | Transcatheter aortic valve replacement after careful candidate consideration is reasonable for patients with critical aortic stenosis who are deemed inoperable. (IIa-B) | C1261287:"Stenosis", C0003483:"Aorta", C0003507:"Aortic Valve Stenosis", C0003506:"Replacement of aortic valve (procedure)", C0035139:"Surgical Replantation", C1269005:"Entire aortic valve", C0009814:"Acquired stenosis", C0003501:"Aortic valve structure", C0947637: | |
| 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) | C0018799:"Heart Diseases", C0018787:"Heart", C0749225:"Systolic dysfunction", C0151744:"Myocardial Ischemia", C1281570:"Entire heart", C0012634:"Disease", C0027061:"Myocardium" | |
| 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. | C0543467:"Operative Surgical Procedures", C0374711:"Surgical repair", C0026264:"Mitral Valve", C0026266:"Mitral Valve Insufficiency", C1269004:"Entire mitral valve" | |
| 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. | C0543467:"Operative Surgical Procedures", C0085612:"Ventricular arrhythmia", C0189598:"Aneurysmectomy", C0003811:"Cardiac Arrhythmia" | |
| 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. | C0309872:"PREVENT (product)" | |
| 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) | C1275743:"Co-morbid conditions", C0007222:"Cardiovascular Diseases", C0199176:"Prophylactic treatment", C0679699:"Secondary Prevention", C0589120:"Follow-up status", C0277555:"Secondary disease, NOS", C0012634:"Disease" | |
| 32651 | Palliative and supportive care is effective for patients with symptomatic advanced Heart Failure to improve quality of life. (I-B) | C0518214:"Perceived quality of life", C0030231:"Palliative Care", C0344211:"Supportive care" | |
| 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. | C2728259:"Program" | |
| 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 | C2242979:"Microbial culture (procedure)", C0441621:"Sampling - Surgical action" | |
| 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:"Antibiotics", C2242979:"Microbial culture (procedure)", C0441621:"Sampling - Surgical action" | |
| 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 | C0444279:"Respiratory sample" | |
| 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 | C0162566:"Porphyria Cutanea Tarda", C0338237:"Antibiotic therapy", C0229671:"Serum", C0003232:"Antibiotics", C0087111:"Therapeutic procedure" | |
| 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 | C0338237:"Antibiotic therapy", C0022100:"Irrigation", C0003232:"Antibiotics", C1535502:"Bronchoalveolar Lavage", C0006279:"Bronchoalveolar Lavage Fluid", C0087111:"Therapeutic procedure" | |
| 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 | C0338237:"Antibiotic therapy", C0003232:"Antibiotics", C0006560:"C-reactive protein", C0087111:"Therapeutic procedure" | |
| 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 | C0338237:"Antibiotic therapy", C0003232:"Antibiotics", C0087111:"Therapeutic procedure" | |
| 32661 | In patients with VAT, we suggest not providing antibiotic therapy | C0338237:"Antibiotic therapy", C0003232:"Antibiotics", C0087111:"Therapeutic procedure" | |
| 32662 | In patients with suspected VAP, we recommend including coverage for S. aureus, Pseudomonas aeruginosa, and other gram-negative bacilli in all empiric regimens | C0449210:"OTH tumor staging notation" | |
| 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 | C0450442:"Agent" | |
| 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). | C1883552:, C0450442:"Agent", C0442811:"Very low" | |
| 32665 | If empiric coverage for MRSA is indicated, we recommend either vancomycin or linezolid | C0042313:"Vancomycin", C0663241:"linezolid" | |
| 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. | C0031955:"Piperacillin", C0020933:"Imipenem", C0027324:"Nafcillin", C1883552:, C0075870:"tazobactam", C0066005:"meropenem", C0055003:"cefepime", C0029983:"Oxacillin", C0450442:"Agent", C0282386:"Levofloxacin", C0007546:"Cefazolin" | |
| 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 | C0027324:"Nafcillin", C0450442:"Agent", C0029983:"Oxacillin", C0007546:"Cefazolin" | |
| 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:"Antibiotics", C0450442:"Agent", C0427965:"Antimicrobial susceptibility" | |
| 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:"Antibiotics", C0450442:"Agent" | |
| 32670 | In patients with suspected VAP, we suggest avoiding aminoglycosides if alternative agents with adequate gram-negative activity are available | C0450442:"Agent", C0002556:"Aminoglycosides" | |
| 32671 | In patients with suspected VAP, we suggest avoiding colistin if alternative agents with adequate gram-negative activity are available | C0450442:"Agent", C0009316:"Colistin" | |
| 32672 | For patients being treated empirically for HAP, we recommend prescribing an antibiotic with activity against S. aureus | C0003232:"Antibiotics" | |
| 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:"Antibiotics", C0343401:"MRSA - Methicillin resistant Staphylococcus aureus infection", C0021311: | |
| 32674 | For patients with HAP who require empiric coverage for MRSA, we recommend vancomycin or linezolid rather than an alternative antibiotic | C0042313:"Vancomycin", C0003232:"Antibiotics", C0663241:"linezolid" | |
| 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 | C0020933:"Imipenem", C0343401:"MRSA - Methicillin resistant Staphylococcus aureus infection", C0066005:"meropenem", C0450442:"Agent", C0282386:"Levofloxacin", C0021311:, C0007546:"Cefazolin", C0031955:"Piperacillin", C0027324:"Nafcillin", C0075870:"tazobactam", C0003232:"Antibiotics", C0055003:"cefepime", C0029983:"Oxacillin" | |
| 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 | C0031955:"Piperacillin", C0027324:"Nafcillin", C0020933:"Imipenem", C0075870:"tazobactam", C0066005:"meropenem", C0055003:"cefepime", C0029983:"Oxacillin", C0450442:"Agent", C0282386:"Levofloxacin", C0007546:"Cefazolin" | |
| 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:"Antibiotics", C0449210:"OTH tumor staging notation" | |
| 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:"Antibiotics", C0449210:"OTH tumor staging notation", C0021311: | |
| 32679 | For patients with HAP who are being treated empirically, we recommend not using an aminoglycoside as the sole antipseudomonal agent | C0450442:"Agent" | |
| 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:"Antibiotics" | |
| 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 | C0032539:"Polymyxins", C0003232:"Antibiotics", C0009316:"Colistin", C0032535:"Polymyxin B", C0002556:"Aminoglycosides" | |
| 32682 | We recommend that MRSA HAP/VAP be treated with either vancomycin or linezolid rather than other antibiotics or antibiotic combinations | C0042313:"Vancomycin", C0003232:"Antibiotics", C0449210:"OTH tumor staging notation", C0663241:"linezolid", C0356164:"Other antibiotics" | |
| 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:"Antibiotics", C0201179:"Antimicrobial susceptibility test (procedure)", C0427965:"Antimicrobial susceptibility", C0087111:"Therapeutic procedure" | |
| 32684 | For patients with HAP/VAP due to P. aeruginosa, we recommend against aminoglycoside monotherapy (strong recommendation, very low-quality evidence). | C0442811:"Very low" | |
| 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 | C0036983:"Septic Shock", C0003232:"Antibiotics", C0556895:"Combination electrotherapy", C0036974:"Shock", C0427965:"Antimicrobial susceptibility", C0087111:"Therapeutic procedure", C1306577:"Death (finding)" | |
| 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 | C0036983:"Septic Shock", C0003232:"Antibiotics", C0556895:"Combination electrotherapy", C0036974:"Shock", C0427965:"Antimicrobial susceptibility", C1306577:"Death (finding)", C0087111:"Therapeutic procedure" | |
| 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:"Antibiotics", C0427965:"Antimicrobial susceptibility", C0087111:"Therapeutic procedure" | |
| 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 | C0006968:"Carbapenems", C0038665:"Sulbactam", C0450442:"Agent", C0002680:"Ampicillin" | |
| 32690 | In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we recommend intravenous polymyxin (colistin or polymyxin B) | C0032539:"Polymyxins", C0009316:"Colistin" | |
| 32691 | In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin | C0032539:"Polymyxins", C0009316:"Colistin" | |
| 32692 | In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin | C0035608:"Rifampin", C0009316:"Colistin" | |
| 32693 | In patients with HAP/VAP caused by Acinetobacter species, we recommend against the use of tigecycline | C1260298:"tigecycline" | |
| 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) | C0032539:"Polymyxins", C0006968:"Carbapenems", C0009316:"Colistin" | |
| 32695 | In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin | C0032539:"Polymyxins", C0006968:"Carbapenems", C0009316:"Colistin" | |
| 32696 | For patients with VAP, we recommend a 7-day course of antimicrobial therapy rather than a longer duration | C0087111:"Therapeutic procedure", C2926735:"Duration" | |
| 32697 | For patients with HAP, we recommend a 7-day course of antimicrobial therapy | C0087111:"Therapeutic procedure" | |
| 32698 | For patients with HAP/VAP, we suggest that antibiotic therapy be de-escalated rather than fixed | C0338237:"Antibiotic therapy", C0003232:"Antibiotics", C0087111:"Therapeutic procedure" | |
| 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 | C0457454:"Discontinuation (procedure)", C2946261:"Level", C0338237:"Antibiotic therapy", C0162566:"Porphyria Cutanea Tarda", C0003232:"Antibiotics", C0087111:"Therapeutic procedure" | |
| 32700 | For patients with suspected HAP/VAP, we suggest not using the CPIS to guide the discontinuation of antibiotic therapy | C0457454:"Discontinuation (procedure)", C0338237:"Antibiotic therapy", C0003232:"Antibiotics", C0087111:"Therapeutic procedure" | |
| 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 | C0034161:"Pus", C0015388:"Exudate", C0200966:"Bacterial stain, routine", C0038128:"Stains", C0021099:"Impetigo", C2242979:"Microbial culture (procedure)", C0061856:"Gram's stain", C1123023:"Skin", C1278993:"Entire skin", C0037284:"Skin lesion", C0013568:"Ecthyma", C0221198:"Lesion" | |
| 32702 | Treatment without gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma is reasonable in typical cases | C0034161:"Pus", C0015388:"Exudate", C0200966:"Bacterial stain, routine", C0038128:"Stains", C0021099:"Impetigo", C2242979:"Microbial culture (procedure)", C0061856:"Gram's stain", C1123023:"Skin", C0037284:"Skin lesion", C1278993:"Entire skin", C0013568:"Ecthyma", C0221198:"Lesion" | |
| 32703 | Treatment of bullous and nonbullous impetigo should be with either mupirocin or retapamulin bid for 5 days | C0021099:"Impetigo", C0021100:"Bullous impetigo", C0085259:"Mupirocin", C1703334:"retapamulin" | |
| 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) | C0030842:"Penicillins", C0021099:"Impetigo", C2242979:"Microbial culture (procedure)", C0450442:"Agent", C0220892:"Penicillin", C0087111:"Therapeutic procedure", C0013568:"Ecthyma" | |
| 32705 | Because Staphylococcus aureus isolates from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or cephalexin is recommended. | C0007716:"Cephalexin", C0021099:"Impetigo", C0025643:"Methicillin", C0012093:"Dicloxacillin", C0013568:"Ecthyma" | |
| 32706 | When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended | C0008947:"Clindamycin", C0038689:"Sulfamethoxazole", C0025643:"Methicillin", C0343401:"MRSA - Methicillin resistant Staphylococcus aureus infection", C0041041:"Trimethoprim", C0013090:"Doxycycline" | |
| 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 | C0021311:, C0017658:"Glomerulonephritis", C0080194:"Muscle strain", C0403414:"Acute post-streptococcal glomerulonephritis" | |
| 32708 | Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases | C0034161:"Pus", C0200966:"Bacterial stain, routine", C0038128:"Stains", C2242979:"Microbial culture (procedure)", C0007078:"carbuncle", C0000833:"Abscess", C0061856:"Gram's stain" | |
| 32709 | Gram stain and culture of pus from inflamed epidermoid cysts are NOT recommended | C0034161:"Pus", C0014511:"Epithelial cyst", C0200966:"Bacterial stain, routine", C0038128:"Stains", C0010709:"Cyst", C2242979:"Microbial culture (procedure)", C0061856:"Gram's stain" | |
| 32710 | Incision and drainage is the recommended treatment for inflamed epidermoid cysts, carbuncles, abscesses and large furuncles | C0242301:"furuncle", C0014511:"Epithelial cyst", C0013103:"Drainage procedure", C0184898:"Surgical incisions", C0010709:"Cyst", C0007078:"carbuncle", C0000833:"Abscess", C0152277:"Incision and drainage", C0012621:"Body Fluid Discharge" | |
| 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 | C0023508:"White Blood Cell Count procedure", C0013103:"Drainage procedure", C0231835:"Tachypnea", C0007584:"Cell Count", C0039082:"Syndrome", C0225386:"Breath", C0039231:"Tachycardia", C0392148:"Providing presence (regime/therapy)", C0007634:"Cells", C0023516:"Leukocytes", C0005767:"Blood", C0184898:"Surgical incisions", C1269647:"Entire cell", C0005773:"Blood Cells", C0003232:"Antibiotics", C0005771:"Blood Cell Count", C0242966:"Systemic Inflammatory Response Syndrome", C1689985:"Absence (morphologic abnormality)", C0012621:"Body Fluid Discharge" | |
| 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 | C0020649:"Hypotension", C0003232:"Antibiotics", C0007078:"carbuncle", C0000833:"Abscess" | |
| 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 | C0031925:"Pilonidal Cyst", C0010709:"Cyst", C0016542:"Foreign Bodies", C0000833:"Abscess", C0021311:, C0085160:"Hidradenitis", C0162836:"Hidradenitis Suppurativa" | |
| 32714 | Recurrent abscesses should be drained and cultured early in the course of infection | C0000833:"Abscess", C0021311: | |
| 32715 | After obtaining cultures of recurrent abscess, treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated | C0003232:"Antibiotics", C2242979:"Microbial culture (procedure)", C0000833:"Abscess" | |
| 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:"Chlorhexidine", C0011121:"Decontamination", C0085259:"Mupirocin", C0021311: | |
| 32717 | Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood | C0027950:"neutrophil", C0000833:"Abscess", C0012634:"Disease" | |
| 32718 | Cultures of blood or cutaneous aspirates, biopsies, or swabs are NOT routinely recommended | C1261188:"Swab", C2242979:"Microbial culture (procedure)", C0370199:"Aspirate substance", C0005767:"Blood" | |
| 32719 | Cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites | C0038561:"Submersion", C0175677:, C0392920:"Chemotherapy Regimen", C0027947:"Neutropenia", C1306459:"Primary malignant neoplasm", C0007634:"Cells", C0005658:"bite injury", C0005767:"Blood", C0021051:"Immunologic Deficiency Syndromes", C1302713:"Injury caused by animal bite", C1269647:"Entire cell", C0003044:"Animal bite", C2242979:"Microbial culture (procedure)", C0013216:"Pharmacotherapy" | |
| 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 ( | C0038561:"Submersion", C0175677:, C0392920:"Chemotherapy Regimen", C0031809:"Physical Examination", C0027947:"Neutropenia", C1306459:"Primary malignant neoplasm", C0370199:"Aspirate substance", C0026018:"Microscopy", C0007634:"Cells", C0005658:"bite injury", C0021051:"Immunologic Deficiency Syndromes", C1261188:"Swab", C1302713:"Injury caused by animal bite", C1269647:"Entire cell", C0003044:"Animal bite", C2242979:"Microbial culture (procedure)", C0013216:"Pharmacotherapy" | |
| 32721 | Typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci | C0243026:"Sepsis", C0450442:"Agent", C0007642:"Cellulitis", C0021311:, C0311392:"Physical findings" | |
| 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) ( | C0243026:"Sepsis", C0025643:"Methicillin", C0003232:"Antibiotics", C0007642:"Cellulitis", C0021311:, C0311392:"Physical findings" | |
| 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 | C0042313:"Vancomycin", C1272883:"Injection", C0343401:"MRSA - Methicillin resistant Staphylococcus aureus infection", C3263723:"Traumatic injury", C0007642:"Cellulitis", C1533685:"Injection procedure", C0021311:, C0043251:"Wounds and Injuries", C0013227:"Pharmaceutical Preparations", C0028429:"Nose" | |
| 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 | C0152009:"White blood cell abnormality", C0020649:"Hypotension", C1294063:"Abnormal blood cell count (procedure)", C0018787:"Heart", C0231835:"Tachypnea", C0021311:, C0311392:"Physical findings", C0007634:"Cells", C0023516:"Leukocytes", C0005767:"Blood", C0243026:"Sepsis", C1269647:"Entire cell", C1278993:"Entire skin", C0023508:"White Blood Cell Count procedure", C0007584:"Cell Count", C0449201:"PER tumor staging notation", C0333794:"Abnormal cellular component of blood", C0039231:"Tachycardia", C0225386:"Breath", C0005758:"Bulla", C1281570:"Entire heart", C0333717:"Abnormal cell", C0027544:"Necrotic debris", C0005773:"Blood Cells", C0003232:"Antibiotics", C0005771:"Blood Cell Count", C1123023:"Skin", C0275521:"Clinical infection" | |
| 32725 | Vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as a reasonable empiric regimen for severe infections | C0031955:"Piperacillin", C0020933:"Imipenem", C0042313:"Vancomycin", C0075870:"tazobactam", C0066005:"meropenem", C0021311: | |
| 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 | C0021311:, C0087111:"Therapeutic procedure", C2926735:"Duration" | |
| 32727 | Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended | C0439775:"Elevation procedure", C0013604:"Edema", C0012634:"Disease" | |
| 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 | C0237849:"Peeling of skin", C1281539:"Entire interdigital space", C0278456:"Structure of interdigital space", C0040357:"Toes", C0015385:"Limb structure", C0333525:"Maceration", C1281589:"Entire toe", C0023216:"Lower Extremity", C0007642:"Cellulitis", C0021311: | |
| 32729 | Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability | C0948268:"Hemodynamic instability", C0278060:"Mental state", C1444783:"Instability", C0087111:"Therapeutic procedure" | |
| 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 | C0021311:, C0087111:"Therapeutic procedure" | |
| 32731 | Systemic corticosteroids (eg, prednisone 40 mg daily for 7 days) could be considered in nondiabetic adult patients with cellulitis | C0001617:"Adrenal Cortex Hormones", C1382730:"Prednisone 40 MG", C0007642:"Cellulitis", C0032952:"Prednisone" | |
| 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. | C0028754:"Obesity", C0013595:"Eczema", C0040357:"Toes", C0332875:"Congenital webbing", C1281589:"Entire toe", C0230506:"Interdigital space of foot", C0013604:"Edema", C0007642:"Cellulitis" | |
| 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 | C0360341:"Erythromycin Oral Product", C0199779:"Administration of antibiotic", C0030842:"Penicillins", C0014806:"Erythromycin", C0003232:"Antibiotics", C1533734:"Administration procedure", C0030829:"penicillin G benzathine", C0007642:"Cellulitis", C0220892:"Penicillin", C0308718:"CONTROL veterinary product" | |
| 32734 | This program should be continued so long as the predisposing factors persist | C2728259:"Program" | |
| 32735 | Suture removal plus incision and drainage should be performed for surgical site infections | C0543467:"Operative Surgical Procedures", C0013103:"Drainage procedure", C0184898:"Surgical incisions", C0015252:"removal technique", C2316459:, C0021311:, C0012621:"Body Fluid Discharge", C0038969:"Surgical sutures" | |
| 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 | C0023508:"White Blood Cell Count procedure", C0018787:"Heart", C0013103:"Drainage procedure", C0021311:, C0041834:"Erythema", C1281570:"Entire heart", C0543467:"Operative Surgical Procedures", C0184898:"Surgical incisions", C2316459:, C0332534:"Induration", C0043250:"Injury wounds", C0012621:"Body Fluid Discharge", C0087111:"Therapeutic procedure" | |
| 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 | C1283900:"Entire head and neck", C1280632:"Entire trunk", C0018670:"Head", C0021311:, C0311392:"Physical findings", C1281592:"Entire neck", C0243026:"Sepsis", C0543467:"Operative Surgical Procedures", C0460005:"Trunk structure", C1281590:"Entire head", C0185774:"Operation on trunk", C0460004:"Head and neck structure", C2316459:, C0027530:"Neck", C0087111:"Therapeutic procedure" | |
| 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 | C0042313:"Vancomycin", C0343401:"MRSA - Methicillin resistant Staphylococcus aureus infection", C0057144:"Daptomycin", C0021311:, C0220892:"Penicillin", C1453642:"telavancin", C0028429:"Nose", C2266959:"Cephalosporin Antibacterial [EPC]", C0030842:"Penicillins", C0304317:"First generation cephalosporin", C0003232:"Antibiotics", C2001521:"ceftaroline", C0663241:"linezolid" | |
| 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 | C1283835:"Entire axillary fossa", C0700038:"Female Reproductive System", C0017421:"Female genitalia", C0015780:, C0450442:"Agent", C0031066:"Anogenital region", C1280088:"Entire perineum", C0021311:, C2266959:"Cephalosporin Antibacterial [EPC]", C0543467:"Operative Surgical Procedures", C0025872:"Metronidazole", C0004454:"Axilla", C1284953:"Entire axillary region", C0559522:"Genital system", C1279154:"Entire axilla" | |
| 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 | C0543467:"Operative Surgical Procedures", C0009818:"Consultation", C1704673:"Gas Dosage Form", C0017105:"Gas Gangrene", C0600688:"Toxic effect", C1602245:"Prompt", C0017110:"Gases", C0021311:, C0017086:"Gangrene", C0238124:"Necrotizing fasciitis", C0311392:"Physical findings", C0015645:"Fasciitis" | |
| 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) | C0031955:"Piperacillin", C0025872:"Metronidazole", C0075870:"tazobactam", C0042313:"Vancomycin", C0006968:"Carbapenems", C0003232:"Antibiotics", C0007561:"Ceftriaxone", C0663241:"linezolid" | |
| 32742 | Penicillin plus clindamycin is recommended for treatment of documented Group A streptococcal necrotizing fasciitis | C0008947:"Clindamycin", C0030842:"Penicillins", C0238124:"Necrotizing fasciitis", C0220892:"Penicillin", C0015645:"Fasciitis", C0854084:"Streptococcal necrotizing fasciitis" | |
| 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. | C1704275:"Pyomyositis", C0040395:"tomography", C0024485:"Magnetic Resonance Imaging", C0011900:"Diagnosis", C0041618:"Ultrasonography", C0011923:"Diagnostic Imaging", C0231881:"Pulmonary resonance", C0040405:"X-Ray Computed Tomography" | |
| 32744 | Cultures of blood and abscess material should be obtained | C2242979:"Microbial culture (procedure)", C0000833:"Abscess", C0005767:"Blood" | |
| 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). | C0042313:"Vancomycin", C3263723:"Traumatic injury", C0450442:"Agent", C0021311:, C0043251:"Wounds and Injuries", C0026845:"Muscle Tissue", C0087111:"Therapeutic procedure" | |
| 32746 | Cefazolin or antistaphylococcal penicillin (eg, nafcillin or oxacillin) is recommended for treatment of pyomyositis caused by MSSA (SR-M). | C0027324:"Nafcillin", C0030842:"Penicillins", C1704275:"Pyomyositis", C0029983:"Oxacillin", C0220892:"Penicillin", C0007546:"Cefazolin" | |
| 32747 | Early drainage of purulent material should be performed | C0013103:"Drainage procedure", C0012621:"Body Fluid Discharge" | |
| 32748 | Repeat imaging studies should be performed in patients with persistent bacteremia to identify undrained foci of infection | C0004610:"Bacteremia", C0021311:, C0011923:"Diagnostic Imaging" | |
| 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. | C0004610:"Bacteremia", C0003232:"Antibiotics", C0000833:"Abscess", C0087111:"Therapeutic procedure", C0014118:"Endocarditis" | |
| 32750 | Urgent surgical exploration of the suspected gas gangrene site and surgical debridement of involved tissue should be performed | C0543467:"Operative Surgical Procedures", C0040300:"Body tissue", C1704673:"Gas Dosage Form", C0017105:"Gas Gangrene", C0011079:"Debridement", C0017110:"Gases", C0017086:"Gangrene", C0184899:"Exploratory incision", C1280903:"Exploration procedure" | |
| 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). | C0031955:"Piperacillin", C0006968:"Carbapenems", C0075870:"tazobactam", C0042313:"Vancomycin", C0038665:"Sulbactam", C0002680:"Ampicillin", C1689985:"Absence (morphologic abnormality)", C0011900:"Diagnosis" | |
| 32752 | Definitive antimicrobial therapy with penicillin and clindamycin is recommended for treatment of clostridial myonecrosis (SR-L). | C0008947:"Clindamycin", C0030842:"Penicillins", C0017105:"Gas Gangrene", C0220892:"Penicillin", C0087111:"Therapeutic procedure" | |
| 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). | C0543467:"Operative Surgical Procedures", C0184633:"Oxygen Therapy Care", C0035273:"Resuscitation procedure", C0011079:"Debridement", C0030054:"Oxygen", C0020431:"Hyperbaric oxygenation therapy", C0087111:"Therapeutic procedure" | |
| 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). | C0175677:, C0015450:"Face", C0031110:"Periosteum", C0018563:"Hand", C1278929:"Entire liver", C1269611:"Entire joint", C0023884:"Liver", C0023895:"Liver diseases", C0022417:"Joints", C1281583:"Entire hand", C1281591:"Entire face", C0006935:"capsule (pharmacologic)", C0013604:"Edema", C0087111:"Therapeutic procedure", C0012634:"Disease" | |
| 32755 | Postexposure prophylaxis for rabies may be indicated. Consultation with local health officials is recommended to determine if vaccination should be initiated (SR-L). | C0034494:"Rabies (disorder)", C0009818:"Consultation", C0199176:"Prophylactic treatment", C0042196:"Vaccination" | |
| 32756 | An antimicrobial agent or agents active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate should be used | C0110038:"Clavulanate", C0450442:"Agent", C0002645:"Amoxicillin" | |
| 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). | C0039620:"Tetanus Vaccine", C0305060:"Tetanus and diphtheria toxoid adsorbed for adult use", C0040555:"Toxoids", C0039614:"Tetanus", C0042196:"Vaccination", C0305062:"tetanus toxoid vaccine, inactivated" | |
| 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. | C0022100:"Irrigation", C0011079:"Debridement", C0015450:"Face", C0003232:"Antibiotics", C0185003:"Reparative closure", C0439631:"Primary operation", C0043250:"Injury wounds", C0441503:"primary closure", C1281591:"Entire face" | |
| 32759 | Other wounds may be approximated (WR-L). | C0449210:"OTH tumor staging notation", C0043250:"Injury wounds" | |
| 32760 | Oral penicillin V 500 mg qid for 7-10 days is the recommended treatment for naturally acquired cutaneous anthrax (SR-H). | C0030842:"Penicillins", C0030840:"Penicillin V", C1125626:"Penicillin V 500 MG", C0003177:"Cutaneous anthrax", C0003175:"Anthrax disease", C0220892:"Penicillin" | |
| 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. | C0150009:"At risk for activity intolerance", C0274281:"Injury due to exposure to external cause", C0231357:"At risk for impaired skin integrity", C0231379:"At risk for joint contractures", C0582456:"At risk of injury", C0231359:"At risk for imbalanced body temperature", C0582147:"At risk of infection", C0231416:"At risk for deficient parenting", C0150032:"At risk for deficient fluid volume", C0231418:"At risk for violence", C1112870:"Aerosol Dose Form", C0992502:"Levofloxacin 500 MG", C0282386:"Levofloxacin", C0150082:"At risk for suffocation", C0150061:"At risk for poisoning injury", C0008809:"Ciprofloxacin", C0231393:"At risk for cognitive impairment", C1123173:"Ciprofloxacin 500 MG" | |
| 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 | C1384489:"Scratch marks", C0052796:"Azithromycin", C0007361:"Cat-Scratch Disease", C0238909:"Cat scratch", C0012634:"Disease" | |
| 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:"Angiomatosis", C0085434:"Angiomatosis, Bacillary", C0014806:"Erythromycin", C1374596:"Erythromycin 500 MG", C1123142:"Doxycycline 100 MG", C0013090:"Doxycycline" | |
| 32764 | Penicillin 500 mg qid or amoxicillin 500 mg tid for 7-10 days is recommended for treatment of erysipeloid (SR-H). | C0993263:"Amoxicillin 500 MG", C0030842:"Penicillins", C1276801:"Infection due to Erysipelothrix rhusiopathiae (disorder)", C0014736:"Erysipelothrix infection", C0002645:"Amoxicillin", C0220892:"Penicillin" | |
| 32765 | Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L). | C0017436:"Gentamicins", C0020933:"Imipenem", C0008809:"Ciprofloxacin", C0013090:"Doxycycline", C0007559:"Ceftazidime" | |
| 32766 | Bubonic plague should be diagnosed by Gram stain and culture of aspirated material from a suppurative lymph node | C0200966:"Bacterial stain, routine", C0038128:"Stains", C0032064:"Plague", C0024202:"Lymph", C2242979:"Microbial culture (procedure)", C1269047:"Entire lymph node", C0061856:"Gram's stain", C0024204:"lymph nodes", C3249881:"Infection - suppurative", C0282312:"Bubonic Plague" | |
| 32767 | Streptomycin 15 mg/kg IM q12h or doxycycline 100 mg bid PO is recommended for treatment of bubonic plague (SR-L). | C0231377:"At risk for impaired home maintenance management", C0150009:"At risk for activity intolerance", C0231357:"At risk for impaired skin integrity", C0231379:"At risk for joint contractures", C0582456:"At risk of injury", C0032064:"Plague", C0038425:"Streptomycin", C0231359:"At risk for imbalanced body temperature", C0582147:"At risk of infection", C0231416:"At risk for deficient parenting", C0150032:"At risk for deficient fluid volume", C0231418:"At risk for violence", C0282312:"Bubonic Plague", C0013090:"Doxycycline", C0150082:"At risk for suffocation", C0150061:"At risk for poisoning injury", C0231393:"At risk for cognitive impairment", C1123142:"Doxycycline 100 MG" | |
| 32768 | Gentamicin could be substituted for streptomycin | C0017436:"Gentamicins", C0038425:"Streptomycin" | |
| 32769 | Serologic tests are the preferred method of diagnosing tularemia (WR-L). | C0041351:"Tularemia", C0036743:"Serologic tests" | |
| 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). | C0017436:"Gentamicins", C0231377:"At risk for impaired home maintenance management", C0038425:"Streptomycin", C0041351:"Tularemia" | |
| 32771 | Tetracycline 500 mg qid or doxycycline 100 mg bid PO is recommended for treatment of mild cases of tularemia (SR-L). | C1123624:"Tetracycline 500 MG", C0150009:"At risk for activity intolerance", C0231379:"At risk for joint contractures", C0231357:"At risk for impaired skin integrity", C0582456:"At risk of injury", C0582147:"At risk of infection", C0231359:"At risk for imbalanced body temperature", C0039644:"Tetracycline", C0231416:"At risk for deficient parenting", C0150032:"At risk for deficient fluid volume", C0231418:"At risk for violence", C0013090:"Doxycycline", C0150082:"At risk for suffocation", C0150061:"At risk for poisoning injury", C0041351:"Tularemia", C0231393:"At risk for cognitive impairment", C1123142:"Doxycycline 100 MG" | |
| 32772 | Notify the microbiology laboratory if tularemia is suspected (SR-H). | C0085672:"Microbiology procedure", C0041351:"Tularemia" | |
| 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). | C0040732:"Transplantation", C0014742:"Erythema Multiforme", C0015230:"Exanthema", C1306459:"Primary malignant neoplasm", C0039082:"Syndrome", C0021311:, C0037284:"Skin lesion", C0151436:"Vasculitis, Leukocytoclastic, Cutaneous", C0221198:"Lesion", C0332835:"Transplanted tissue", C0302295:"Eruptions", C0702249:"Infiltration (procedure)", C1278993:"Entire skin", C0013216:"Pharmacotherapy", C2973529:"Leukocytoclastic vasculitis", C0392920:"Chemotherapy Regimen", C0041834:"Erythema", C0011609:"Drug Eruptions", C0011906:"Differential Diagnosis", C0332448:"Infiltration", C0042384:"Vasculitis", C0011900:"Diagnosis", C1123023:"Skin", C0013227:"Pharmaceutical Preparations", C0012634:"Disease" | |
| 32774 | Differential diagnosis for infection of skin lesions should include bacterial, fungal, viral and parasitic agents (SR-H). | C0011906:"Differential Diagnosis", C0304207:"Bacterial product", C0037278:"Skin Diseases, Infectious", C0450442:"Agent", C0011900:"Diagnosis", C1123023:"Skin", C0021311:, C1278993:"Entire skin", C0037284:"Skin lesion", C1268919:"Fungal product", C0221198:"Lesion" | |
| 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). | C0220787:"Endotracheal aspiration", C1261322:"Evaluation procedure", C0700198:"Pulmonary aspiration", C0349707:"Aspiration-action", C0005558:"Biopsy", C0221198:"Lesion" | |
| 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) | C0027947:"Neutropenia", C0015967:"Fever" | |
| 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 | C0040300:"Body tissue", C0150866:"Biopsy of skin procedure", C0149778:"Soft Tissue Infection", C0038128:"Stains", C0037278:"Skin Diseases, Infectious", C0700198:"Pulmonary aspiration", C0684084:"Skin tissue", C0021311:, C0349707:"Aspiration-action", C0221198:"Lesion", C0005558:"Biopsy", C0220787:"Endotracheal aspiration", C0410013:"Soft tissue lesion", C0200965:"Microbial staining", C0225317:"soft tissue", C2242979:"Microbial culture (procedure)", C1261322:"Evaluation procedure", C1298701:"Microbial stain", C1123023:"Skin", C1278993:"Entire skin" | |
| 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 | C1269647:"Entire cell", C0027947:"Neutropenia", C0344211:"Supportive care", C0021311:, C0007634:"Cells", C0015967:"Fever" | |
| 32779 | Determine the extent of infection through a thorough physical examination, blood cultures, chest radiograph and additional imaging (including chest CT) | C2242979:"Microbial culture (procedure)", C0031809:"Physical Examination", C0817096:"Chest", C1306645:"Plain x-ray", C0202823:"Chest CT", C0021311:, C0011923:"Diagnostic Imaging", C0200949:"Blood culture", C0005767:"Blood" | |
| 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 | C0020933:"Imipenem", C0006968:"Carbapenems", C0042313:"Vancomycin", C0003232:"Antibiotics", C0055003:"cefepime", C0066005:"meropenem", C0389169:"doripenem", C0008777:"Cilastatin", C0087111:"Therapeutic procedure", C0279516:"Anti-Bacterial Agents" | |
| 32781 | Documented clinical and microbiologic skin and soft tissue infections should be treated based on antimicrobial susceptibilities of isolated organisms | C0040300:"Body tissue", C0149778:"Soft Tissue Infection", C0225317:"soft tissue", C0037278:"Skin Diseases, Infectious", C0684084:"Skin tissue", C1123023:"Skin", C0021311:, C1278993:"Entire skin" | |
| 32782 | The treatment duration for most bacterial skin and soft tissue infections should be 7-14 days | C0040300:"Body tissue", C0149778:"Soft Tissue Infection", C0225317:"soft tissue", C0037278:"Skin Diseases, Infectious", C0684084:"Skin tissue", C0021311:, C1123023:"Skin", C1278993:"Entire skin", C0004623:"Bacterial Infections", C2926735:"Duration" | |
| 32783 | Surgical intervention is recommended for drainage of soft-tissue abscess after marrow recovery or for a progressive polymicrobial necrotizing fasciitis or myonecrosis | C0344096:"Drainage of abscess", C0040300:"Body tissue", C0543467:"Operative Surgical Procedures", C0013103:"Drainage procedure", C0225317:"soft tissue", C0000833:"Abscess", C1273869:"Intervention regimes", C0012621:"Body Fluid Discharge", C0015645:"Fasciitis" | |
| 32784 | Adjunct colony-stimulating factor therapy (G-CSF, GM-CSF) or granulocyte transfusions | C0018183:"granulocyte", C1879316:"Transfusion (procedure)", C0087111:"Therapeutic procedure" | |
| 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). | C0019348:"Herpes Simplex Infections", C0021311:, C0008049:"Chickenpox", C0019360:"Herpes zoster disease", C0001367:"Acyclovir" | |
| 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). | C0027947:"Neutropenia", C0439631:"Primary operation", C0003308:"Antifungal Agents", C0021311:, C0279516:"Anti-Bacterial Agents", C0087111:"Therapeutic procedure", C0015967:"Fever" | |
| 32787 | Empiric administration of vancomycin or other agents with Gram-positive activity (linezolid, daptomycin or ceftaroline) should be added if not already being administered | C0042313:"Vancomycin", C1533734:"Administration procedure", C0450442:"Agent", C2001521:"ceftaroline", C0449210:"OTH tumor staging notation", C0663241:"linezolid", C0057144:"Daptomycin" | |
| 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) | C0040300:"Body tissue", C0149778:"Soft Tissue Infection", C0085795:"Amphotericin", C0037278:"Skin Diseases, Infectious", C0684084:"Skin tissue", C0006840:"Candidiasis", C0021311:, C0002679:"Amphotericin B", C0023779:"Lipids", C1268551:"Echinocandins", C0225317:"soft tissue", C1123023:"Skin", C1278993:"Entire skin" | |
| 32789 | if Candida parapsilosis has been isolated treat with fluconazole as an acceptable alternative to lipid formulation amphotericin-B | C0085795:"Amphotericin", C0016277:"Fluconazole", C0002679:"Amphotericin B", C0023779:"Lipids" | |
| 32790 | Treatment should be for 2 weeks after clearance of blood stream infection or resolution of skin lesions. | C0021311:, C1123023:"Skin", C1278993:"Entire skin", C0037284:"Skin lesion", C0005767:"Blood", C0221198:"Lesion" | |
| 32791 | Aspergillus skin and soft tissue infections should be treated with voriconazole | C0040300:"Body tissue", C0149778:"Soft Tissue Infection", C0393080:"voriconazole", C0225317:"soft tissue", C0037278:"Skin Diseases, Infectious", C0684084:"Skin tissue", C1123023:"Skin", C0021311:, C1278993:"Entire skin" | |
| 32792 | alternatively to voriconazole treat Aspergillus skin and soft tissue infections with lipid formulations of amphotericin B, posaconazole or echinocandin for 6-12 weeks | C0936148:"posaconazole", C0040300:"Body tissue", C0149778:"Soft Tissue Infection", C0085795:"Amphotericin", C0037278:"Skin Diseases, Infectious", C0684084:"Skin tissue", C0021311:, C0002679:"Amphotericin B", C0023779:"Lipids", C1268551:"Echinocandins", C0225317:"soft tissue", C0393080:"voriconazole", C1123023:"Skin", C1278993:"Entire skin" | |
| 32793 | Mucor/Rhizopus infections should be treated with lipid formulation amphotericin B | C0085795:"Amphotericin", C0021311:, C0002679:"Amphotericin B", C0023779:"Lipids" | |
| 32794 | Mucor/Rhizopus infections should be treated with posaconazole | C0936148:"posaconazole", C0021311: | |
| 32795 | The addition of an echinocandin could be considered based on synergy in murine models of mucormycosis and observational clinical data (WR-L). | C0026718:"Mucormycosis", C1268551:"Echinocandins" | |
| 32796 | Fusarium species infections should be treated with high-dose IV voriconazole or posaconazole | C0936148:"posaconazole", C0393080:"voriconazole", C0276758:"Fusariosis", C0021311: | |
| 32797 | Begin treatment for antibiotic-resistant bacterial organisms (Table 6) in patients currently on antibiotics. | C0003232:"Antibiotics" | |
| 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). | C0021311:, C0001367:"Acyclovir" | |
| 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 | C0700198:"Pulmonary aspiration", C0728940:"Excision", C0349707:"Aspiration-action", C0037284:"Skin lesion", C0005767:"Blood", C0221198:"Lesion", C0005558:"Biopsy", C0220787:"Endotracheal aspiration", C0543467:"Operative Surgical Procedures", C2242979:"Microbial culture (procedure)", C1123023:"Skin", C1278993:"Entire skin", C0200949:"Blood culture" | |
| 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). | C0032520:"Polymerase Chain Reaction", C0011900:"Diagnosis", C0021311:, C1123023:"Skin", C0037284:"Skin lesion", C1278993:"Entire skin", C0221198:"Lesion", C0229664:"peripheral blood", C0005767:"Blood" | |
| 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) | C0040732:"Transplantation", C0009818:"Consultation", C0332835:"Transplanted tissue", C0024299:"Lymphoma", C0021311:, C1533651:"Deficiency of cell-mediated immunity", C0023418:"leukemia", C0013227:"Pharmaceutical Preparations", C0301889:"Immune defect", C0023448:"Lymphoid leukemia" | |
| 32802 | Consider biopsy and surgical debridement early in the management of these patients | C0543467:"Operative Surgical Procedures", C0011079:"Debridement", C0005558:"Biopsy" | |
| 32803 | Empiric antibiotics, antifungals and/or antivirals should be considered | C0003232:"Antibiotics", C0003308:"Antifungal Agents" | |
| 32804 | The use of specific agents should be decided with the input of the primary team, dermatology, infectious disease and other consulting teams | C0009450:"Communicable Diseases", C0450442:"Agent", C0439631:"Primary operation", C0449210:"OTH tumor staging notation", C0012634:"Disease" | |
| 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. | C0003486:"Aortic Aneurysm", C0162871:"Aortic Aneurysm, Abdominal", C0000726:"Abdomen", C0442037:"Popliteal", C1261322:"Evaluation procedure", C0003483:"Aorta", C0031809:"Physical Examination", C0015811:"Femur", C0002940:"Aneurysm" |