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GUÍAS CLÍNICAS


15 mayo 2022

2022 ACC Health Policy Statement on Building Respect, Civility, and Inclusion in the Cardiovascular Workplace: A Report of the American College of Cardiology Solution Set Oversight Committee

Writing Committee, Pamela S. Douglas, Michael J. Mack, David A. Acosta, Emelia J. Benjamin, Cathleen Biga, Sharonne N. Hayes, Nkechinyere N. Ijioma, Lisa Jay-Fuchs, Akshay K. Khandelwal, John A. McPherson, Jennifer H. Mieres, Robert O. Roswell, Partho P. Sengupta, Natalie Stokes, Enid A. Wade, and Clyde W. Yancy

The American College of Cardiology (ACC) has a long history of developing documents (eg, decision pathways, health policy statements [HPS], appropriate use criteria) to provide its members with guidance on both clinical and nonclinical topics relevant to cardiovascular care. In most circumstances, these documents have been created to complement clinical practice guidelines and to inform clinicians about areas where evidence may be new and evolving or where sufficient data may be more limited. Despite this, numerous care gaps continue to exist, highlighting the need for more streamlined and efficient processes to implement best practices in service to improved patient care.

15 mayo 2022

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play: A Report of the American College of Cardiology Solution Set Oversight Committee

Writing Committee, Ty J. Gluckman, Nicole M. Bhave, Larry A. Allen, Eugene H. Chung, Erica S. Spatz, Enrico Ammirati, Aaron L. Baggish, Biykem Bozkurt, William K. Cornwell, Kimberly G. Harmon, Jonathan H. Kim, Anuradha Lala, Benjamin D. Levine, Matthew W. Martinez, Oyere Onuma, Dermot Phelan, Valentina O. Puntmann, Saurabh Rajpal, Pam R. Taub, and Amanda K. Verma

The American College of Cardiology (ACC) has a long history of developing documents (eg, decision pathways, health policy statements, appropriate use criteria) to provide members with guidance on both clinical and nonclinical topics relevant to cardiovascular care. In most circumstances, these documents have been created to complement clinical practice guidelines and to inform clinicians about areas where evidence may be new and evolving or where sufficient data may be more limited. Despite this, numerous care gaps continue to exist, highlighting the need for more streamlined and efficient processes to implement best practices in service to improved patient care.

15 mayo 2022

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Paul A. Heidenreich, Biykem Bozkurt, David Aguilar, Larry A. Allen, Joni J. Byun, Monica M. Colvin, Anita Deswal, Mark H. Drazner, Shannon M. Dunlay, Linda R. Evers, James C. Fang, Savitri E. Fedson, Gregg C. Fonarow, Salim S. Hayek, Adrian F. Hernandez, Prateeti Khazanie, Michelle M. Kittleson, Christopher S. Lee, Mark S. Link, Carmelo A. Milano, Lorraine C. Nnacheta, Alexander T. Sandhu, Lynne Warner Stevenson, Orly Vardeny, Amanda R. Vest, and Clyde W. Yancy

Aim The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” replaces the “2013 ACCF/AHA Guideline for the Management of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.

15 mayo 2022

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Paul A. Heidenreich, Biykem Bozkurt, David Aguilar, Larry A. Allen, Joni J. Byun, Monica M. Colvin, Anita Deswal, Mark H. Drazner, Shannon M. Dunlay, Linda R. Evers, James C. Fang, Savitri E. Fedson, Gregg C. Fonarow, Salim S. Hayek, Adrian F. Hernandez, Prateeti Khazanie, Michelle M. Kittleson, Christopher S. Lee, Mark S. Link, Carmelo A. Milano, Lorraine C. Nnacheta, Alexander T. Sandhu, Lynne Warner Stevenson, Orly Vardeny, Amanda R. Vest, and Clyde W. Yancy

Aim The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” replaces the “2013 ACCF/AHA Guideline for the Management of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.

15 marzo 2022

SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021.

Srihari S. Naidu, David A. Baran, Jacob C. Jentzer, Steven M. Hollenberg, Sean van Diepen, Mir B. Basir, Cindy L. Grines, Deborah B. Diercks, Shelley Hall, Navin K. Kapur, William Kent, Sunil V. Rao, Marc D. Samsky, Holger Thiele, Alexander G. Truesdell, and Timothy D. Henry

Since its development and release in 2019, the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification for adult patients has been widely cited and increasingly incorporated, owing to its simplicity across all clinical settings, easily understood and visualized framework, and notable endorsement by relevant societies and organizations that manage cardiogenic shock (CS).1 Ensuing validation studies over the course of the subsequent 2 years documented both its ease and rapidity of use as well as its ability to meaningfully discriminate patient risk across the spectrum of CS, including various phenotypes, presentations, and health care settings. Nonetheless, several areas of potential refinement have been identified to make the classification scheme more applicable across all settings and clinical time points, given that data from validation studies have provided useful information not previously available that could serve to significantly refine the classification. With this background, a clinical expert consensus writing group of all relevant stakeholders was reconvened to re-evaluate and refine the SCAI SHOCK stage classification based on the existing literature and clinician feedback from real-world experience.

15 julio 2022

2022 AHA/ACC Key Data Elements and Definitions for Cardiovascular and Noncardiovascular Complications of COVID-19: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards

Writing Committee Members, Biykem Bozkurt, Sandeep R. Das, Daniel Addison, Aakriti Gupta, Hani Jneid, Sadiya S. Khan, George Augustine Koromia, Prathit A. Kulkarni, Kathleen LaPoint, Eldrin F. Lewis, Erin D. Michos, Pamela N. Peterson, Mohit K. Turagam, Tracy Y. Wang, and Clyde W. Yancy

The American College of Cardiology (ACC) and the American Heart Association (AHA) support their members’ goal to improve the prevention and treatment of cardiovascular diseases (CVDs) through professional education, research, the development of guidelines and standards, and by fostering policy that supports optimal patient care and outcomes. The ACC and AHA also recognize the importance of using clinical data standards for patient management, assessment of outcomes, and conduct of research, as well as the importance of defining the processes and outcomes of clinical care, whether in randomized trials, observational studies, registries, or quality improvement initiatives.

05 septiembre 2017

CIRCULATION. Methodological Standards for Meta-Analyses and Qualitative Systematic Reviews of Cardiac Prevention and Treatment Studies: A Scientific Statement From the American Heart Association

Goutham Rao, Francisco Lopez-Jimenez, Jack Boyd, Frank D’Amico, Nefertiti H. Durant, Mark A. Hlatky, George Howard, Katherine Kirley, Christopher Masi, Tiffany M. Powell-Wiley, Anthony E. Solomonides, Colin P. West and Jennifer Wessel

Meta-analyses are becoming increasingly popular, especially in the fields of cardiovascular disease prevention and treatment. They are often considered to be a reliable source of evidence for making healthcare decisions. Unfortunately, problems among meta-analyses such as the misapplication and misinterpretation of statistical methods and tests are long-standing and widespread. The purposes of this statement are to review key steps in the development of a meta-analysis and to provide recommendations that will be useful for carrying out meta-analyses and for readers and journal editors, who must interpret the findings and gauge methodological quality. To make the statement practical and accessible, detailed descriptions of statistical methods have been omitted. Based on a survey of cardiovascular meta-analyses, published literature on methodology, expert consultation, and consensus among the writing group, key recommendations are provided. Recommendations reinforce several current practices, including protocol registration; comprehensive search strategies; methods for data extraction and abstraction; methods for identifying, measuring, and dealing with heterogeneity; and statistical methods for pooling results. Other practices should be discontinued, including the use of levels of evidence and evidence hierarchies to gauge the value and impact of different study designs (including meta-analyses) and the use of structured tools to assess the quality of studies to be included in a meta-analysis. We also recommend choosing a pooling model for conventional meta-analyses (fixed effect or random effects) on the basis of clinical and methodological similarities among studies to be included, rather than the results of a test for statistical heterogeneity.

13 junio 2017

CIRCULATION. Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support: A Scientific Statement From the American Heart Association

Mary Ann Peberdy, Jason A. Gluck, Joseph P. Ornato, Christian A. Bermudez, Russell E. Griffin, Vigneshwar Kasirajan, Richard E. Kerber, Eldrin F. Lewis, Mark S. Link, Corinne Miller, Jeffrey J. Teuteberg, Ravi Thiagarajan, Robert M. Weiss and Brian O’Neil

Cardiac arrest in patients on mechanical support is a new phenomenon brought about by the increased use of this therapy in patients with end-stage heart failure. This American Heart Association scientific statement highlights the recognition and treatment of cardiovascular collapse or cardiopulmonary arrest in an adult or pediatric patient who has a ventricular assist device or total artificial heart. Specific, expert consensus recommendations are provided for the role of external chest compressions in such patients.

20 junio 2017

CIRCULATION. Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

Jennifer L. Cook, Monica Colvin, Gary S. Francis, Kathleen L. Grady, Timothy M. Hoffman, Mariell Jessup, Ranjit John, Michael S. Kiernan, Judith E. Mitchell, Francis D. Pagani, Michael Petty, Pasala Ravichandran, Joseph G. Rogers, Marc J. Semigran and J. Matthew Toole

Mechanical circulatory support (MCS) offers a surgical option for advanced heart failure when optimal medical therapy is inadequate. MCS therapy improves prognosis, functional status, and quality of life. The INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) tracks patient selection and outcomes for all implanted US Food and Drug Administration–approved MCS devices. From June 2006 until December 2014, >15 000 patients received MCS, and >2000 implantations are performed annually.

01 marzo 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. 2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults With Aortic Stenosis: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents

Catherine M. Otto, Dharam J. Kumbhani, Karen P. Alexander, John H. Calhoon, Milind Y. Desai, Sanjay Kaul, James C. Lee, Carlos E. Ruiz and Christina M. Vassileva

Transcatheter aortic valve replacement (TAVR) is a new and transformational technology for patients with severe aortic valvular stenosis. Although currently approved for use in patients with severe symptomatic aortic stenosis (AS) who are at intermediate to high surgical risk or are inoperable, it is likely that it will be utilized outside of clinical trials in lower-risk surgical candidates in the future. Since the first U.S. Food and Drug Administration approval in 2011, over 50,000 patients have undergone TAVR in the United States alone. Multiple studies have documented favorable outcomes using a wide spectrum of endpoints, including survival, symptom status, quality of life, and need for repeat hospitalizations. The implementation of TAVR into the flow of patient care is complex, involving a Heart Valve Team and consideration of several key factors, such as clinical site selection, operator and team training and experience, patient selection and evaluation, procedural performance and complication management, and postprocedural care. Collaborative stakeholder involvement is required in the successful management of this high-risk patient population with extensive coexistent medical conditions. The intent of this clinical expert consensus pathway is to provide additional details and practical guidance about TAVR with point-of-care checklists and algorithms. These have been separated into 4 sections: 1) preprocedure evaluation of the patient being considered for TAVR; 2) imaging modalities and measurements; 3) key issues in performing the TAVR procedure; and 4) recommendations for patient follow-up after TAVR.

01 marzo 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients

Donald M. Lloyd-Jones, Mark D. Huffman, Kunal N. Karmali, Darshak M. Sanghavi, Janet S. Wright, Colleen Pelser, Martha Gulati, Frederick A. Masoudi and David C. Goff Jr.

The Million Hearts Initiative has a goal of preventing 1 million heart attacks and strokes—the leading causes of mortality—through several public health and healthcare strategies by 2017. The American Heart Association and American College of Cardiology support the program. The Cardiovascular Risk Reduction Model was developed by Million Hearts and the Center for Medicare & Medicaid Services as a strategy to assess a value-based payment approach toward reduction in 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) by implementing cardiovascular preventive strategies to manage the “ABCS” (aspirin therapy in appropriate patients, blood pressure control, cholesterol management, and smoking cessation). The purpose of this special report is to describe the development and intended use of the Million Hearts Longitudinal ASCVD Risk Assessment Tool. The Million Hearts Tool reinforces and builds on the “2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk” by allowing clinicians to estimate baseline and updated 10-year ASCVD risk estimates for primary prevention patients adhering to the appropriate ABCS over time, alone or in combination. The tool provides updated risk estimates based on evidence from high-quality systematic reviews and meta-analyses of the ABCS therapies. This novel approach to personalized estimation of benefits from risk-reducing therapies in primary prevention may help target therapies to those in whom they will provide the greatest benefit, and serves as the basis for a Center for Medicare & Medicaid Services program designed to evaluate the Million Hearts Cardiovascular Risk Reduction Model.

01 mayo 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons

Manesh R. Patel, John H. Calhoon, Gregory J. Dehmer, James Aaron Grantham, Thomas M. Maddox, David J. Maron and Peter K. Smith

The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.

01 mayo 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society

Michael W. Rich, Deborah A. Chyun, Adam H. Skolnick, Karen P. Alexander, Daniel E. Forman, Dalane W. Kitzman, Mathew S. Maurer, James B. McClurken, Barbara M. Resnick, Win K. Shen, David L. Tirschwell, on behalf of the American Heart Association Older Populations Committee of the Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council and American College of Cardiology; and American Geriatrics Society

The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults >=75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged >=75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world.

01 mayo 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Natural History, Diagnostic Approaches, and Therapeutic Strategies for Patients With Asymptomatic Severe Aortic Stenosis

Philippe Généreux, Gregg W. Stone, Patrick T. O’Gara, Guillaume Marquis-Gravel, Björn Redfors, Gennaro Giustino, Philippe Pibarot, Jeroen J. Bax, Robert O. Bonow and Martin B. Leon

Aortic stenosis (AS) is one of the most common valvular diseases encountered in clinical practice. Current guidelines recommend aortic valve replacement (AVR) when the aortic valve is severely stenotic and the patient is symptomatic; however, a substantial proportion of patients with severe AS are asymptomatic at the time of first diagnosis. Although specific morphological valve features, exercise testing, stress imaging, and biomarkers can help to identify patients with asymptomatic severe AS who may benefit from early AVR, the optimal management of these patients remains uncertain and controversial. The current report presents a comprehensive review of the natural history and the diagnostic evaluation of asymptomatic patients with severe AS, and is followed by a meta-analysis from reported studies comparing an early AVR strategy to active surveillance, with an emphasis on the level of evidence substantiating the current guideline recommendations. Finally, perspectives on directions for future investigation are discussed.

01 mayo 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. SCAI/ACC/HRS Institutional and Operator Requirements for Left Atrial Appendage Occlusion

Clifford J. Kavinsky, Fred M. Kusumoto, Anthony A. Bavry, Steven R. Bailey, Kenneth A. Ellenbogen, Paul L. Hess, Daniel L. Lustgarten, Issam D. Moussa and Christian Spies

schemic stroke remains a significant risk for patients with atrial fibrillation (AF). The Food and Drug Administration (FDA) approval of the WATCHMAN device for percutaneous closure of the left atrial appendage (LAA) represents an important addition to the physician’s armamentarium to help mitigate this problem. The evolution of LAA occlusion technology has spanned nearly two decades and three FDA panel hearings, leading to FDA approval in 2015. As this technology becomes clinically available to a broader population of patients, it is essential that physician stakeholders establish criteria for the performance of these procedures that will be used in granting initial and ongoing privileges. These criteria are offered to support The Joint Commission mandate that medical staff privileges be granted on the basis of professional criteria specified in the medical staff bylaws to ensure safe and effective patient-centered care. The emergence of transcatheter valve therapies has provided a model whereby multiple societies collaborate to provide recommendations to institutions and operators to assess their potential to establish and maintain programs for these therapies (1–3). As an extension of this concept, the Society of Cardiovascular Angiography and Interventions (SCAI), the Heart Rhythm Society (HRS), and the American College of Cardiology (ACC) agreed to provide recommendations to institutions and interested physicians for the establishment and maintenance of LAA occlusion programs. An initial multisociety overview of the field of LAA occlusion has recently been published, highlighting the critical issues surrounding LAA occlusion therapies (4). This document states that the questions of who should perform these procedures and the institutional support required need further delineation. It is these issues that are the subject of this, the second multisociety document. As LAA occlusion is in its early developmental stages, the recommendations must initially rely on expert consensus. As experience with LAA occlusion grows, these recommendations will be revised and updated based on expanded expertise and published data. However, the recent FDA approval of the first percutaneous LAA occlusion device underscores the need to make initial recommendations now; this will provide a starting point for future modifications. The recommendations that follow were reviewed by the entire writing committee, with at least 70% concurrence required in order to be incorporated.

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