Class III A recommendations in guidelines for cardiovascular medicine
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| Class III Recommendations in Guidelines for Cardiovascular Medicine |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Aparna Vuppala, M.B.B.S. [2]
Overview
LOE A is defined as evidence obtained from either multiple populations, multiple randomized clinical trials, or meta-analyses of randomized clinical trials. The total number of class III-LOE A recommendations in guidelines published by American cardiology societies is 57.
Class III A Recommendations: Organized by Guideline Keywords
The table shown below is a list of class III A recommendations obtained from American guidelines for cardiovascular medicine. 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.
| Number | Guideline Keywords | Year of Guideline Publication | Title of Guideline | Class III Recommendation | Level of Evidence | Effect |
| 1 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | At present, no pharmacological agents with putative neuroprotective actions have demonstrated efficacy in improving outcomes after ischemic stroke, and therefore, other neuroprotective agents are not recommended. | A | N/A |
| 2 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Because of lack of evidence of efficacy and the potential to increase the risk of infectious complications, corticosteroids (in conventional or large doses) are not recommended for treatment of cerebral edema and increased ICP complicating ischemic stroke. | A | N/A |
| 3 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Frank hypodensity on NECT may increase the risk of hemorrhage with fibrinolysis and should be considered in treatment decisions. If frank hypodensity involves more than one third of the MCA territory, intravenous rtPA treatment should be withheld. | A | N/A |
| 4 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Hemodilution by volume expansion is not recommended for treatment of patients with acute ischemic stroke. | A | N/A |
| 5 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The administration of vasodilatory agents, such as pentoxifylline, is not recommended for treatment of patients with acute ischemic stroke. | A | N/A |
| 6 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The intravenous administration of streptokinase for treatment of stroke is not recommended. | A | N/A |
| 7 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Urgent anticoagulation for the management of noncerebrovascular conditions is not recommended for patients with moderate-to-severe strokes because of an increased risk of serious intracranial hemorrhagic complications. | A | Harm |
| 8 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Urgent anticoagulation, with the goal of preventing early recurrent stroke, halting neurological worsening, or improving outcomes after acute ischemic stroke, is not recommended for treatment of patients with acute ischemic stroke. | A | N/A |
| 9 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine use of pulmonary artery catheterization in patients, even those with elevated risk, is not recommended. | A | No benefit |
| 10 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Pregnancy in patients with atrial septal defect (ASD) and severe PAH (Eisenmenger syndrome) is not recommended owing to excessive maternal and fetal mortality and should be strongly discouraged. | A | Harm |
| 11 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Pregnancy in patients with ventricular septal defect (VSD) and severe PAH (Eisenmenger syndrome) is not recommended owing to excessive maternal and fetal mortality and should be strongly discouraged. | A | Harm |
| 12 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Prophylactic administration of lidocaine is not recommended for the management of arrhythmias / ventricular rhythm disorders. | A | N/A |
| 13 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Prophylactic antiarrhythmics are not recommended for patients with suspected ACS or myocardial infarction in the prehospital or ED. | A | N/A |
| 14 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Routine administration of magnesium sulfate in cardiac arrest is not recommended unless torsades de pointes is present. | A | N/A |
| 15 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | In patients with cardiac arrest and without known PE, routine fibrinolytic treatment given during CPR shows no benefit and is not recommended. | A | No benefit |
| 16 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for torsade de pointes VT due to reversible causes. | A | N/A |
| 17 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | CK should not be routinely measured in individuals receiving statin therapy. | A | No benefit |
| 18 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | It may be harmful to initiate simvastatin at 80 mg daily or increase the dose of simvastatin to 80 mg daily. | A | Harm |
| 19 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Initiating beta-blocker therapy in beta-blocker–naïve patients the night before and/or the morning of noncardiac surgery is not recommended. | A | N/A |
| 20 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Except in extraordinary circumstances, carotid revascularization by either CEA or CAS is not recommended when atherosclerosis narrows the lumen by less than 50%. | A | No benefit |
| 21 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Fetal medical therapy is of no benefit for fetuses with sinus bradycardia, irregular rhythms caused by extrasystolic beats. | A | N/A |
| 22 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for maternal medications including SSRIs (other than paroxetine). | A | N/A |
| 23 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Calcium channel–blocking drugs are not recommended as routine treatment for patients with HFrEF. | A | No benefit |
| 24 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Statins are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications for their use. | A | No benefit |
| 25 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Antioxidant vitamin supplements (eg, vitamins E, C, or beta carotene) should not be used for secondary prevention in patients with NSTE-ACS. | A | No benefit |
| 26 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Folic acid, with or without vitamins B6 and B12, should not be used for secondary prevention in patients with NSTE-ACS. | A | No benefit |
| 27 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Hormone therapy with estrogen plus progestin, or estrogen alone, should not be given as new drugs for secondary prevention of coronary events to postmenopausal women after NSTE-ACS and should not be continued in previous users unless the benefits outweigh the estimated risks. | A | Harm |
| 28 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | In patients with NSTE-ACS (ie, without ST-elevation, true posterior MI, or left bundle-branch block not known to be old), intravenous fibrinolytic therapy should not be used. | A | Harm |
| 29 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | With contemporary troponin assays, creatine kinase myocardial isoenzyme (CK-MB) and myoglobin are not useful for diagnosis of ACS. | A | No benefit |
| 30 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Administration of N-acetyl-L-cysteine is not useful for the prevention of contrast-induced acute kidney injury. | A | No benefit |
| 31 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Cutting balloon angioplasty should not be performed routinely during PCI. | A | No benefit |
| 32 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Laser angioplasty should not be used routinely during PCI. | A | No benefit |
| 33 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Rotational atherectomy should not be performed routinely for de novo lesions or in-stent restenosis. | A | No benefit |
| 34 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Oral vasodilator prostaglandins such as beraprost and iloprost are not effective medications to improve walking distance in patients with intermittent claudication. | A | N/A |
| 35 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Chelation (e.g., ethylenediaminetetraacetic acid) is not indicated for treatment of intermittent claudication and may have harmful adverse effects. | A | Harm |
| 36 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Intervention is not recommended for asymptomatic infrarenal or juxtarenal AAAs if they measure less than 5.0 cm in diameter in men or less than 4.5 cm in diameter in women. | A | N/A |
| 37 | Postthrombotic syndrome | 2014 | The Postthrombotic Syndrome - Evidence-Based Prevention, Diagnosis, and Treatment Strategies | Recommendations for Thrombolysis and Endovascular Approaches to Acute DVT for the Prevention of PTS Systemic thrombolysis is not recommended for the treatment of DVT. | A | N/A |
| 38 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Aspirin is not useful for preventing a first stroke in persons at low risk. | A | N/A |
| 39 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Hormone therapy (CEE with or without MPA) should not be used for primary prevention of stroke in postmenopausal women. | A | N/A |
| 40 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Screening for cardiac conditions such as PFO in the absence of neurological conditions or a specific cardiac cause is not recommended | A | N/A |
| 41 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | SERMs, such as raloxifene, tamoxifen, or tibolone, should not be used for primary prevention of stroke. | A | N/A |
| 42 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Treatment with antibiotics for chronic infections as a means to prevent stroke is not recommended. | A | N/A |
| 43 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Among patients with LV dysfunction (EF <35%), ICD therapy is not recommended for the prevention of sudden cardiac death after CABG until 3 months of postoperative goal-directed medical therapy has been provided and persistent LV dysfunction has been confirmed. | A | N/A |
| 44 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Warfarin should not be routinely prescribed after CABG for graft patency unless patients have other indications for long-term antithrombotic therapy (such as AF, venous thromboembolism, or a mechanical prosthetic valve). | A | N/A |
| 45 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with a cryptogenic ischemic stroke or TIA and a PFO without evidence for DVT, available data do not support a benefit for PFO closure. | A | N/A |
| 46 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with a recent (within 6 months) TIA or ischemic stroke ipsilateral to a stenosis or occlusion of the middle cerebral or carotid artery, EC/IC bypass surgery is not recommended. | A | N/A |
| 47 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Routine supplementation with a single vitamin or combination of vitamins is not recommended. | A | N/A |
| 48 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | The combination of aspirin and clopidogrel, when initiated days to years after a minor stroke or TIA and continued for 2 to 3 years, increases the risk of hemorrhage relative to either agent alone and is not recommended for routine long-term secondary prevention after ischemic stroke or TIA. | A | N/A |
| 49 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | When the degree of stenosis is <50%, CEA and CAS are not recommended. | A | N/A |
| 50 | Spontaneous intracerebral hemorrhage | 2008 | Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults | Delayed evacuation by craniotomy appears to offer little if any benefit with a fairly high degree of certainty. In those patients presenting in coma with deep hemorrhages, removal of ICH by craniotomy may actually worsen outcome and is not recommended. | A | Harm |
| 51 | Spontaneous intracerebral hemorrhage | 2008 | Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults | With a few exceptions, the routine evacuation of supratentorial ICH by standard craniotomy within 96 hours of ictus is generally not recommended. | A | N/A |
| 52 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | Estrogen therapy is not recommended in postmenopausal women with SIHD with the intent of reducing cardiovascular risk or improving clinical outcomes. | A | No benefit |
| 53 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | Treatment of elevated homocysteine with folate or vitamins B6 and B12 is not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD. | A | No benefit |
| 54 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | Vitamin C, vitamin E, and beta-carotene supplementation are not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD. | A | No benefit |
| 55 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Statin therapy is not indicated for prevention of hemodynamic progression of AS in patients with mild-to-moderate calcific valve disease (stages B to D). | A | No benefit |
| 56 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Class IC antiarrhythmic drugs in patients with a past history of MI should not be used. | A | No benefit |
| 57 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | Systemic fibrinolysis should not be given routinely to patients with IFDVT. | A | N/A |
Class III A Recommendations: Organized by Year of Guideline Publication
The table shown below is a list of class III A recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by year of guideline publication. Alternatively, to view the same list organized by guideline name/keywords, click here.
| Number | Guideline Keywords | Year of Guideline Publication | Title of Guideline | Class III Recommendation | Level of Evidence | Effect |
| 1 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Among patients with LV dysfunction (EF <35%), ICD therapy is not recommended for the prevention of sudden cardiac death after CABG until 3 months of postoperative goal-directed medical therapy has been provided and persistent LV dysfunction has been confirmed. | A | N/A |
| 2 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Warfarin should not be routinely prescribed after CABG for graft patency unless patients have other indications for long-term antithrombotic therapy (such as AF, venous thromboembolism, or a mechanical prosthetic valve). | A | N/A |
| 3 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine use of pulmonary artery catheterization in patients, even those with elevated risk, is not recommended. | A | No benefit |
| 4 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Fetal medical therapy is of no benefit for fetuses with sinus bradycardia, irregular rhythms caused by extrasystolic beats. | A | N/A |
| 5 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for maternal medications including SSRIs (other than paroxetine). | A | N/A |
| 6 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Antioxidant vitamin supplements (eg, vitamins E, C, or beta carotene) should not be used for secondary prevention in patients with NSTE-ACS. | A | No benefit |
| 7 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Folic acid, with or without vitamins B6 and B12, should not be used for secondary prevention in patients with NSTE-ACS. | A | No benefit |
| 8 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Hormone therapy with estrogen plus progestin, or estrogen alone, should not be given as new drugs for secondary prevention of coronary events to postmenopausal women after NSTE-ACS and should not be continued in previous users unless the benefits outweigh the estimated risks. | A | Harm |
| 9 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | In patients with NSTE-ACS (ie, without ST-elevation, true posterior MI, or left bundle-branch block not known to be old), intravenous fibrinolytic therapy should not be used. | A | Harm |
| 10 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | With contemporary troponin assays, creatine kinase myocardial isoenzyme (CK-MB) and myoglobin are not useful for diagnosis of ACS. | A | No benefit |
| 11 | Postthrombotic syndrome | 2014 | The Postthrombotic Syndrome - Evidence-Based Prevention, Diagnosis, and Treatment Strategies | Recommendations for Thrombolysis and Endovascular Approaches to Acute DVT for the Prevention of PTS Systemic thrombolysis is not recommended for the treatment of DVT. | A | N/A |
| 12 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with a cryptogenic ischemic stroke or TIA and a PFO without evidence for DVT, available data do not support a benefit for PFO closure. | A | N/A |
| 13 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with a recent (within 6 months) TIA or ischemic stroke ipsilateral to a stenosis or occlusion of the middle cerebral or carotid artery, EC/IC bypass surgery is not recommended. | A | N/A |
| 14 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Routine supplementation with a single vitamin or combination of vitamins is not recommended. | A | N/A |
| 15 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | The combination of aspirin and clopidogrel, when initiated days to years after a minor stroke or TIA and continued for 2 to 3 years, increases the risk of hemorrhage relative to either agent alone and is not recommended for routine long-term secondary prevention after ischemic stroke or TIA. | A | N/A |
| 16 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | When the degree of stenosis is <50%, CEA and CAS are not recommended. | A | N/A |
| 17 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Statin therapy is not indicated for prevention of hemodynamic progression of AS in patients with mild-to-moderate calcific valve disease (stages B to D). | A | No benefit |
| 18 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | At present, no pharmacological agents with putative neuroprotective actions have demonstrated efficacy in improving outcomes after ischemic stroke, and therefore, other neuroprotective agents are not recommended. | A | N/A |
| 19 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Because of lack of evidence of efficacy and the potential to increase the risk of infectious complications, corticosteroids (in conventional or large doses) are not recommended for treatment of cerebral edema and increased ICP complicating ischemic stroke. | A | N/A |
| 20 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Frank hypodensity on NECT may increase the risk of hemorrhage with fibrinolysis and should be considered in treatment decisions. If frank hypodensity involves more than one third of the MCA territory, intravenous rtPA treatment should be withheld. | A | N/A |
| 21 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Hemodilution by volume expansion is not recommended for treatment of patients with acute ischemic stroke. | A | N/A |
| 22 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The administration of vasodilatory agents, such as pentoxifylline, is not recommended for treatment of patients with acute ischemic stroke. | A | N/A |
| 23 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The intravenous administration of streptokinase for treatment of stroke is not recommended. | A | N/A |
| 24 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Urgent anticoagulation for the management of noncerebrovascular conditions is not recommended for patients with moderate-to-severe strokes because of an increased risk of serious intracranial hemorrhagic complications. | A | Harm |
| 25 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Urgent anticoagulation, with the goal of preventing early recurrent stroke, halting neurological worsening, or improving outcomes after acute ischemic stroke, is not recommended for treatment of patients with acute ischemic stroke. | A | N/A |
| 26 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | CK should not be routinely measured in individuals receiving statin therapy. | A | No benefit |
| 27 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | It may be harmful to initiate simvastatin at 80 mg daily or increase the dose of simvastatin to 80 mg daily. | A | Harm |
| 28 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Calcium channel–blocking drugs are not recommended as routine treatment for patients with HFrEF. | A | No benefit |
| 29 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Statins are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications for their use. | A | No benefit |
| 30 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Initiating beta-blocker therapy in beta-blocker–naïve patients the night before and/or the morning of noncardiac surgery is not recommended. | A | N/A |
| 31 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | Estrogen therapy is not recommended in postmenopausal women with SIHD with the intent of reducing cardiovascular risk or improving clinical outcomes. | A | No benefit |
| 32 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | Treatment of elevated homocysteine with folate or vitamins B6 and B12 is not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD. | A | No benefit |
| 33 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | Vitamin C, vitamin E, and beta-carotene supplementation are not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD. | A | No benefit |
| 34 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Except in extraordinary circumstances, carotid revascularization by either CEA or CAS is not recommended when atherosclerosis narrows the lumen by less than 50%. | A | No benefit |
| 35 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Administration of N-acetyl-L-cysteine is not useful for the prevention of contrast-induced acute kidney injury. | A | No benefit |
| 36 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Cutting balloon angioplasty should not be performed routinely during PCI. | A | No benefit |
| 37 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Laser angioplasty should not be used routinely during PCI. | A | No benefit |
| 38 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Rotational atherectomy should not be performed routinely for de novo lesions or in-stent restenosis. | A | No benefit |
| 39 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Aspirin is not useful for preventing a first stroke in persons at low risk. | A | N/A |
| 40 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Hormone therapy (CEE with or without MPA) should not be used for primary prevention of stroke in postmenopausal women. | A | N/A |
| 41 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Screening for cardiac conditions such as PFO in the absence of neurological conditions or a specific cardiac cause is not recommended | A | N/A |
| 42 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | SERMs, such as raloxifene, tamoxifen, or tibolone, should not be used for primary prevention of stroke. | A | N/A |
| 43 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Treatment with antibiotics for chronic infections as a means to prevent stroke is not recommended. | A | N/A |
| 44 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | Systemic fibrinolysis should not be given routinely to patients with IFDVT. | A | N/A |
| 45 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Prophylactic administration of lidocaine is not recommended for the management of arrhythmias / ventricular rhythm disorders. | A | N/A |
| 46 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Prophylactic antiarrhythmics are not recommended for patients with suspected ACS or myocardial infarction in the prehospital or ED. | A | N/A |
| 47 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Routine administration of magnesium sulfate in cardiac arrest is not recommended unless torsades de pointes is present. | A | N/A |
| 48 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | In patients with cardiac arrest and without known PE, routine fibrinolytic treatment given during CPR shows no benefit and is not recommended. | A | No benefit |
| 49 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Pregnancy in patients with atrial septal defect (ASD) and severe PAH (Eisenmenger syndrome) is not recommended owing to excessive maternal and fetal mortality and should be strongly discouraged. | A | Harm |
| 50 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Pregnancy in patients with ventricular septal defect (VSD) and severe PAH (Eisenmenger syndrome) is not recommended owing to excessive maternal and fetal mortality and should be strongly discouraged. | A | Harm |
| 51 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for torsade de pointes VT due to reversible causes. | A | N/A |
| 52 | Spontaneous intracerebral hemorrhage | 2008 | Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults | Delayed evacuation by craniotomy appears to offer little if any benefit with a fairly high degree of certainty. In those patients presenting in coma with deep hemorrhages, removal of ICH by craniotomy may actually worsen outcome and is not recommended. | A | Harm |
| 53 | Spontaneous intracerebral hemorrhage | 2008 | Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults | With a few exceptions, the routine evacuation of supratentorial ICH by standard craniotomy within 96 hours of ictus is generally not recommended. | A | N/A |
| 54 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Class IC antiarrhythmic drugs in patients with a past history of MI should not be used. | A | No benefit |
| 55 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Oral vasodilator prostaglandins such as beraprost and iloprost are not effective medications to improve walking distance in patients with intermittent claudication. | A | N/A |
| 56 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Chelation (e.g., ethylenediaminetetraacetic acid) is not indicated for treatment of intermittent claudication and may have harmful adverse effects. | A | Harm |
| 57 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Intervention is not recommended for asymptomatic infrarenal or juxtarenal AAAs if they measure less than 5.0 cm in diameter in men or less than 4.5 cm in diameter in women. | A | N/A |