Persius/hicric huggingface dataset:
Rhythm Control Demonstrated as Equally Effective as Rate Control in Preventing CV Mortality
November 6, 2007 By Scott Williams 
Orlando, FL:  The AF-CHF trial demonstrated no differences in cardiovascular mortality among patients with atrial fibrillation (AF) and heart failure (HF) in either the rhythm control or rate control study groups through a mean follow up of 3 years.  The results were presented by Dr. Denis Roy at the AHAs Scientific Sessions.
The AF-CHF study enrolled 1376 patients with heart failure and atrial fibrillation to study the effects of rate control versus rhythm control among these patients.  To be considered as having HF, patients had to be classified as having New York Heart Association (NYHA) class II to class IV congestive heart failure and a left ventricular (LVEF) ejection fraction of equal to or less than 35%, or NYHA class I classification with prior hospitalization for heart failure or an LVEF equal to or less than 25%.  A document clinically significant episode of AF within the past 6 months was also required for inclusion in the study.  The trials population had a mean age of 67 years and 18% were females.
682 patients were randomized to receive rhythm control treatments consisting of electrical cardioversion with amiodarone as the first choice as an antiarrythmic drug (82% of patients in the rhythm control group).  Sotalol (1.8% of patients) and dofetilide (0.4% of patients) were administered as necessary.  The trials other 694 patients received beta-blockers (88% of patients), digoxin (75% of patients), or pacemaker and AV node ablation as necessary.  There was a crossover rate of 10% from the rhythm control group to the rate control group, and 21% from the rate control group to the rhythm control group.
Through the mean follow up period of 3 years there was no significant difference displayed between the two groups for the studys primary endpoint of cardiovascular death (26.7% in the rhythm population vs. 25.2% in the rate population, p=0.59).  Differences between the secondary endpoints of all cause mortality, stroke and worsening HF were also non significant.  Two areas where rhythm control and rate controlled differed were in the rate of cardioversion (39% vs. 8%, p=0.0001) and the frequency of bradyarrhythmias (8.5% vs. 4.9%, p=0.007).
Although prior studies have attributed negative hemodynamic effects to atrial fibrillation, rhythm control appeared to be equally as safe and effective as rate control in preventing cardiovascular mortality and worsening heart failure.
References
1. Originally presented at AHA Scientific Sessions 2007 by Dr. Denis Roy.
ACC/AHA recommendations for surgical intervention in L-transposition of the great arteries

# Overview
ACC/AHA recommends different surgical options for patients with congenitally corrected/Levo-transposition of the great arteries. In some cases, the technically challenging "double switch operation" has been successfully performed to restore the normal blood flow through the appropriate morphologic ventricles.

# ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)

## Surgical Intervention (DO NOT EDIT)
The Living Guidelines: Maintenance of sinus rhythm: Polling Results for CLASS I Guidelines

# Class I Guidelines
1. Before initiating antiarrhythmic drug therapy, treatment of precipitating or reversible causes of AF is recommended. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 1 for maintenance of sinus rhythm should be:
The Living Guidelines: Preventing Thromboembolism Polling Results for CLASS IIa Guidelines

# Class IIa Guidelines
1. For primary prevention of thromboembolism in patients with non valvular AF who have just 1 of the following validated risk factors, antithrombotic therapy with either aspirin or a vitamin K antagonist is reasonable, based upon an assessment of the risk of bleeding complications, ability to safely sustain adjusted chronic anticoagulation, and patient preferences: age greater than or equal to 75 y (especially in female patients), hypertension, heart failure, impaired LV function, or diabetes mellitus. (Level of Evidence: A) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 1 for preventing thromboembolism should be:
2. For patients with non valvular AF who have 1 or more of the following less well-validated risk factors, antithrombotic therapy with either aspirin or a vitamin K antagonist is reasonable for prevention of thromboembolism: age 65 to 74 y, female gender, or CAD. The choice of agent should be based upon the risk of bleeding complications, ability to safely sustain adjusted chronic anticoagulation, and patient preferences. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2 for preventing thromboembolism should be:
3. It is reasonable to select antithrombotic therapy using the same criteria irrespective of the pattern (i.e., paroxysmal, persistent, or permanent) of AF. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 3 for preventing thromboembolism should be:
4. In patients with AF who do not have mechanical prosthetic heart valves, it is reasonable to interrupt anticoagulation for up to 1 week without substituting heparin for surgical or diagnostic procedures that carry a risk of bleeding. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 4 for preventing thromboembolism should be:
5. It is reasonable to reevaluate the need for anticoagulation at regular intervals. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 5 for preventing thromboembolism should be:
ACC AHA recommendations for evaluation of the unoperated patient in atrial septal defect

# Overview
ACC/AHA recommends for different diagnostic tools that could be used to evaluate a patient of atrial septal defect

# ACC/AHA recommendations for evaluation of the unoperated patient with atrial septal defect 
For ACC/AHA Level of evidence and classes click:ACC AHA Guidelines Classification Scheme
Left ventriculography Left Ventricular Ejection Fraction Assessment by Visual Estimation

# Overview
Left ventricular ejection fraction (LVEF) can be visually estimated by comparing the contour of the left ventricle (LV) between the end-systolic frame and the end-diastolic frame on left ventriculography.

# Calculation
By definition, the volume of blood within a ventricle at the end of diastole is the end-diastolic volume (EDV). Likewise, the volume of blood left in a ventricle at the end of systole (contraction) is the end-systolic volume (ESV). The difference between EDV and ESV is the stroke volume (SV). The ejection fraction is the fraction of the end-diastolic volume that is ejected with each beat; that is, it is stroke volume (SV) divided by end-diastolic volume (EDV):
EF (\%) = \frac{SV}{EDV}\times100
Where the stroke volume is given by:
SV = EDV - ESV
EF is inherently a relative measurementas is any fraction, ratio, or percentage, whereas the stroke volume, end-diastolic volume or end-systolic volume are absolute measurements.

# Classification
According to the ACC Heart Failure Clinical Toolkit, based on the quantitative results of LVEF assessment, left ventricular function can be classified into the following qualitative categories:
- Hyperdynamic = LVEF greater than 70%
- Normal = LVEF 50% to 70% (midpoint 60%)
- Mild dysfunction = LVEF 40% to 49% (midpoint 45%)
- Moderate dysfunction = LVEF 30% to 39% (midpoint 35%)
- Severe dysfunction = LVEF less than 30%

# Examples

## Hyperdynamic (>70%)

### Case 1: LVEF  75%

## Normal LVEF (5070%)

### Case 2: LVEF  60%

## Mild dysfunction (4049%)

### Case 3: LVEF  45%

## Moderate dysfunction (3039%)

### Case 4: LVEF  35%
The Living Guidelines: Preventing Thromboembolism Polling Results for CLASS I Guidelines

# Class I Guidelines
1. Antithrombotic therapy to prevent thromboembolism is recommended for all patients with AF, except those with lone AF or contraindications. (Level of Evidence: A) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 1 for preventing thromboembolism should be:
2. The selection of the antithrombotic agent should be based upon the absolute risks of stroke and bleeding and the relative risk and benefit for a given patient. (Level of Evidence: A) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 2 for preventing thromboembolism should be:
3. For patients without mechanical heart valves at high risk of stroke, chronic oral anticoagulant therapy with a vitamin K antagonist is recommended in a dose adjusted to achieve the target intensity INR of 2.0 to 3.0, unless contraindicated. Factors associated with highest risk for stroke in patients with AF are prior thromboembolism (stroke, TIA, or systemic embolism) and rheumatic mitral stenosis. (Level of Evidence: A) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 3 for preventing thromboembolism should be:
4. Anticoagulation with a vitamin K]] antagonist is recommended for patients with more than 1 moderate risk factor. Such factors include age 75 y or greater, hypertension, HF, impaired LV systolic function (ejection fraction 35% or less or fractional shortening less than 25%), and diabetes mellitus. (Level of Evidence: A) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 4 for preventing thromboembolism should be:
5. INR should be determined at least weekly during initiation of therapy and monthly when anticoagulation is stable. (Level of Evidence: A) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 5 for preventing thromboembolism should be:
6. Aspirin, 81325 mg daily, is recommended as an alternative to vitamin K antagonists in low-risk patients or in those with contraindications to oral anticoagulation. (Level of Evidence: A) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 6 for preventing thromboembolism should be:
7. For patients with AF who have mechanical heart valves, the target intensity of anticoagulation should be based on the type of prosthesis, maintaining an INR of at least 2.5. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 7 for preventing thromboembolism should be:
8. Antithrombotic therapy is recommended for patients with atrial flutter as for those with AF. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 8 for preventing thromboembolism should be:
The Living Guidelines: Pregnant patients: Suggest Revisions to the CLASS IIb Guidelines

# Class IIb Guidelines
- Administration of heparin may be considered during the first trimester and last month of pregnancy for patients with AF and risk factors for thromboembolism. Unfractionated heparin may be administered either by continuous intravenous infusion in a dose sufficient to prolong the activated partial thromboplastin time to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) activated partial thromboplastin time to 1.5 times control. (Level of Evidence: B) 
- Despite the limited data available, subcutaneous administration of low molecular weight heparin may be considered during the first trimester and last month of pregnancy for patients with AF and risk factors for thromboembolism. (Level of Evidence: C) 
- Administration of an oral anticoagulant may be considered during the second trimester for pregnant patients with AF at high thromboembolic risk. (Level of Evidence: C) 
- Administration of quinidine or procainamide may be considered to achieve pharmacological cardioversion in hemodynamically stable patients who develop AF during pregnancy. (Level of Evidence: C)
Class III recommendations in guidelines for cardiovascular medicine list of guidelines

# Overview
A total of 65 guidelines published by American cardiology societies are used to populate all 584 class III recommendations. Only the most updated publication for each guideline and its focused update are chosen to populate the list of class III recommendations.

# Organized by Guideline Keywords
The table shown below is a list of guidelines for cardiovascular medicine published by American cardiology societies. The list is organized by guideline name/keywords in alphabetical order. Alternatively, to view the same list organized by year of guideline publication, click here.

# Organized by Year of Guideline Publication
The table shown below is the list of guidelines for cardiovascular medicine published by American cardiology societies. The list is organized by guideline year of guideline publication (newest to oldest). Alternatively, to view the same list organized by guideline name/keywords, click here.
The Living Guidelines: Pregnant patients: Suggest Revisions to the CLASS I Guidelines

# Class I Guidelines
- Digoxin, a beta blocker, or a non dihydropyridine calcium channel antagonist is recommended to control the rate of ventricular response in pregnant patients with AF. (Level of Evidence: C) 
- Direct-current cardioversion is recommended in pregnant patients who become hemodynamically unstable due to AF. (Level of Evidence: C) 
- Protection against thromboembolism is recommended throughout pregnancy for all patients with AF (except those with lone AF and/or low thromboembolic risk). Therapy (anticoagulant or aspirin) should be chosen according to the stage of pregnancy. (Level of Evidence: C)
Management of Atherosclerotic Risk Factors in Patients With Vertebral Artery Disease

# Management of Atherosclerotic Risk Factors in Patients With Vertebral Artery Disease

## 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease (DO NOT EDIT)

### Management of Atherosclerotic Risk Factors in Patients with Vertebral Artery Disease (DO NOT EDIT)
ACC AHA guidelines for evaluation of unoperated patients with atrial septal defects

# Overview
Different modalities of treatment could be used to diagnose and determine the amount of shunting across the atrial septal defect. Maximal exercise testing can be used in patients with symptoms that are discrepant with clinical findings or to document changes in oxygen saturation in patients with mild or moderate pulmonary artery hypertension.

# 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

## Recommendations for Atrial Septal Defect

# 2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)

## Recommendations for Evaluation of the Unoperated Patient (DO NOT EDIT)
AHA/ASA guideline recommendations for of Early management of acute ischemic stroke

# 2018 AHA/ASA Guidelines for the early Management of Acute Ischemic Stroke
The AHA/ASA published the following guidelines for management of acute ischemic stroke in March, 2018:

## Prehospital Stroke Management

## Designation of Stroke Centers and Stroke Care, Quality Improvement Process

## Emergency Triage and Initial Evaluation

## Parenchymal Brain Imaging

### Recommendations for Patients With Acute Cerebral Ischemic Symptoms That Have Not Yet Resolved

### Recommendations for Patients With Cerebral Ischemic Symptoms That Have Resolved

## General Supportive Care and Treatment of Acute Complications

## Intravenous Fibrinolysis

## Management after Systemic Intravenous Fibrinolytic Therapy
- Admit the patient to intensive care unit or stroke unit for monitoring
- If the patient develops severe headache, acute hypertension, nausea, or vomiting or has a worsening neurological examination, discontinue the infusion (if IV alteplase is being administered) and obtain emergency head CT scan
- Measure BP and perform neurological assessments every 15 min during and after IV alteplase infusion for 2 h, then every 30 min for 6 h, then hourly until 24 h after IV alteplase treatment
- Increase the frequency of BP measurements if SBP is >180 mmHg or if DBP is >105 mmHg; administer antihypertensive medications to maintain BP at or below these levels
- Delay placement of nasogastric tubes, indwelling bladder catheters, or intraarterial pressure catheters if the patient can be safely managed without them
- Obtain a follow-up CT or MRI scan at 24 h after IV alteplase before starting anticoagulants or antiplatelet agents

## Endovascular Interventions

## Anticoagulants

## Antiplatelets

## Volume Expansion, Vasodilators, and Induced Hypertension

## Neuroprotective Agents

## Surgical Interventions

## General Stroke Care

## Treatment of Acute Neurological Complications
Management of chronic limb ischemia in lower extremity peripheral arterial disease

# 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

# Recommendations for Management of CLI (critical limb ischemia) in the Patient With PAD

## Recommendation for Revascularization for CLI:

### Recommendations for Endovascular Revascularization for CLI:

### Recommendations for Surgical Revascularization for CLI:

## Recommendation for Wound Healing Therapy:
Remote ischemic preconditioning may improve clinical outcomes after CABG procedure
August 23, 2007 By Katherine Ogando
London, England: Coronary bypass patients may experience better outcomes following surgery thanks to remote ischemic preconditioning, a technique which induces ischemia and reperfusion in a distant region from the heart and may reduce the risk of myocardial injury after coronary artery bypass graft surgery.
According to a randomized controlled trial recently published in [/ The Lancet, remote ischemic preconditioning offered a significant improvement in clinical outcomes of patients who underwent elective coronary artery bypass graft surgery.  The study included a total of 57 adult patients, 30 of which were randomly assigned to the control group and 27 to the remote ischemic preconditioning group.  Remote ischemic preconditioning was performed by restricting blood flow to the right arm in three 5-minute cycles by inflating an arm cuff to 200 mmHg, and reperfusing the arm by deflating the arm cuff.
Troponin-T, a perioperative cardiac enzyme, was used as an indicator of the outcome of the procedure.  Since high levels of serum troponin-T following an intervention have been associated with an increased risk of morbidity and mortality, the authors suggest positive clinical outcomes may result from the significant decrease of 43% in serum troponin-T, from 36.12 g/L in the control to 20.58 g/L in the experimental group at 6, 12, 24, and 48 hours after surgery.  Measurements at 72 hours did not show a significant reduction in troponin-T.
The authors hypothesize that remote ischemic preconditioning triggers a protective mechanism in the heart, which may consequently reduce the size and damage of a subsequent myocardial infarction following surgery.  Despite the fact that the exact method in which this protective mechanism works is still uncertain, Hausenloy et al. are optimistic of the potential of remote ischemic preconditioning, stating in their published article, One might expect that in high-risk patients for whom serum troponin-T concentrations are substantially greater, remote ischemic preconditioning might confer an even greater reduction in myocardial injury.
Larger trials would be needed to further validate these findings and to determine if the biomarker reduction would translate into improved clinical outcomes.
References
D Hausenloy, P K Mwamure, V Venugopal, J Harris, M Barnard, E Grundy, E Ashley, S Vichare, C DiSalvo, S Kovekar, M Hayward, B Keogh, R J MacAllister, D M Yellon. Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: A randomised controlled trial. The Lancet 2007; 370: 575-79.
The Living Guidelines: Pregnant patients: Polling Results for CLASS IIb Guidelines

# Class IIb Guidelines
1. Administration of heparin may be considered during the first trimester and last month of pregnancy for patients with AF and risk factors for thromboembolism. Unfractionated heparin may be administered either by continuous intravenous infusion in a dose sufficient to prolong the activated partial thromboplastin time to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) activated partial thromboplastin time to 1.5 times control. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIb Recommendation 1 for pregnant patients with acute myocardial infarction should be:
2. Despite the limited data available, subcutaneous administration of low molecular weight heparin may be considered during the first trimester and last month of pregnancy for patients with AF and risk factors for thromboembolism. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIb Recommendation 2 for pregnant patients with acute myocardial infarction should be:
3. Administration of an oral anticoagulant may be considered during the second trimester for pregnant patients with AF at high thromboembolic risk. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIb Recommendation 3 for pregnant patients with acute myocardial infarction should be:
4. Administration of quinidine or procainamide may be considered to achieve pharmacological cardioversion in hemodynamically stable patients who develop AF during pregnancy. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIb Recommendation 4 for pregnant patients with acute myocardial infarction should be: