Class III B 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 B is defined as evidence obtained from either a limited number of populations, a single randomized clinical trial, or meta-analyses of non-randomized studies. The total number of class III-LOE B recommendations in guidelines published by American cardiology societies is 229.
Class III B Recommendations: Organized by Guideline Keywords
The table shown below is a list of class III B 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 | Aspirin is not recommended as a substitute for other acute interventions for treatment of stroke, including intravenous rtPA. | B | N/A |
| 2 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Data on the utility of hyperbaric oxygen are inconclusive, and some data imply that the intervention may be harmful. Thus, with the exception of stroke secondary to air embolization, this intervention is not recommended for treatment of patients with acute ischemic stroke. | B | N/A |
| 3 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Initiation of anticoagulant therapy within 24 hours of treatment with intravenous rtPA is not recommended. | B | N/A |
| 4 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Routine use of nutritional supplements has not been shown to be beneficial. | B | N/A |
| 5 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Routine use of prophylactic antibiotics has not been shown to be beneficial. | B | N/A |
| 6 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Supplemental oxygen is not recommended in nonhypoxic patients with acute ischemic stroke. | B | N/A |
| 7 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The administration of other intravenous antiplatelet agents that inhibit the glycoprotein IIb/IIIa receptor is not recommended. | B | N/A |
| 8 | Arteriotomy closure devices | 2010 | Arteriotomy Closure Devices for Cardiovascular Procedures | ACDs should not be used routinely for the specific purpose of reducing vascular complications in patients undergoing invasive cardiovascular procedures via the femoral artery approach. | B | N/A |
| 9 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Administration of intravenous amiodarone, adenosine, digoxin (oral or intravenous), or nondihydropyridine calcium channel antagonists (oral or intravenous) in patients with Wolff-Parkinson-White syndrome who have pre-excited AF is potentially harmful because these drugs accelerate the ventricular rate. | B | Harm |
| 10 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Dofetilide therapy should not be initiated out of hospital because of the risk of excessive QT prolongation that can cause torsades de pointes. | B | Harm |
| 11 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Dronedarone should not be used for treatment of AF in patients with New York Heart Association class III and IV HF or patients who have had an episode of decompensated HF in the past 4 weeks. | B | Harm |
| 12 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Dronedarone should not be used to control the ventricular rate in patients with permanent AF as it increases the risk of the combined endpoint of stroke, myocardial infarction, systemic embolism, or cardiovascular death. | B | Harm |
| 13 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Dronedarone, in specific, for rhythm control should not be continued when AF becomes permanent. | B | Harm |
| 14 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | In patients with pre-excitation and AF, digoxin, nondihydropyridine calcium channel antagonists, or intravenous amiodarone should not be administered as they may increase the ventricular response and may result in ventricular fibrillation. | B | Harm |
| 15 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | The direct thrombin inhibitor dabigatran should not be used in patients with AF and a mechanical heart valve. | B | Harm |
| 16 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Therapy with an ACE inhibitor, ARB, or statin is not beneficial for primary prevention of AF in patients without cardiovascular disease. | B | No benefit |
| 17 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | Routine blood biomarker testing for the sole purpose of risk stratification in patients with heart failure is not warranted. | B | No benefit |
| 18 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | Routine blood BNP or NT-proBNP testing is not warranted for making specific therapeutic decisions for patients with acute or chronic heart failure because of the still emerging but incomplete data as well as intra- and inter-individual variations. | B | No benefit |
| 19 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | Routine blood natriuretic peptide (BNP or NT-proBNP) testing is not recommended for screening large asymptomatic patient populations for left ventricular dysfunction. | B | No benefit |
| 20 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | CABG or PCI should not be performed with the primary or sole intent to improve survival in patients with SIHD with 1 or more coronary stenoses that are not anatomically or functionally significant (eg, <70% diameter non–left main coronary artery stenosis, fractional flow reserve >0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium. | B | Harm |
| 21 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Cyclooxygenase-2 inhibitors are not recommended for pain relief in the postoperative period after CABG. | B | Harm |
| 22 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Discontinuation of statin or other dyslipidemic therapy is not recommended before or after CABG in patients without adverse reactions to therapy. | B | Harm |
| 23 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | PCI to improve survival should not be performed in stable patients with significant (>50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG. | B | Harm |
| 24 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | PCI with coronary stenting (bare-metal stent or drug-eluting stent) should not be performed if the patient is not likely to be able to tolerate and comply with dual antiplatelet therapy for the appropriate duration of treatment based on the type of stent implanted. | B | Harm |
| 25 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Postmenopausal hormonal therapy (estrogen/prosgesterone) should not be administered to women undergoing CABG. | B | Harm |
| 26 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter secundum ASD closure is not indicated in patients with a small secundum ASD of no hemodynamic significance and with no other risk factors. | B | N/A |
| 27 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Neonates, infants, and children with a small to moderate-sized MVSD (without symptoms or evidence of pulmonary hypertension) in whom there is a reasonable expectation that the defect will become smaller over time should be followed up expectantly and do not need closure of the VSD. | B | N/A |
| 28 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Neonates, infants, and children with hemodynamically significant (left ventricular or left atrial volume overload or pulmonary-to-systemic blood flow ratio >2 1) inlet MVSDs with inadequate space between the defect and the atrioventricular or semilunar valves should not undergo device closure (hybrid or percutaneous). | B | N/A |
| 29 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Pulmonary valvuloplasty should not be performed in patients with pulmonary atresia and RV-dependent coronary circulation. | B | N/A |
| 30 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter balloon valvuloplasty is not indicated for patients with congenital mitral valve stenosis due to supramitral valve ring or associated with hypoplastic left ventricle. | B | N/A |
| 31 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Alpha-2 agonists for prevention of cardiac events are not recommended in patients who are undergoing noncardiac surgery. | B | No benefit |
| 32 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Beta-blocker therapy should not be started on the day of surgery. | B | Harm |
| 33 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Elective noncardiac surgery should not be performed within 30 days after BMS implantation or within 12 months after DES implantation in patients in whom dual antiplatelet therapy will need to be discontinued perioperatively. | B | Harm |
| 34 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | For patients with a low risk of perioperative MACE, further testing is not recommended before the planned operation. | B | No benefit |
| 35 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | It is not recommended that routine coronary revascularization be performed before noncardiac surgery exclusively to reduce perioperative cardiac events. | B | No benefit |
| 36 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Prophylactic intravenous nitroglycerin is not effective in reducing myocardial ischemia in patients undergoing noncardiac surgery. | B | No benefit |
| 37 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine postoperative screening with troponin levels in unselected patients without signs or symptoms suggestive of myocardial ischemia or MI is not useful for guiding perioperative management. | B | No benefit |
| 38 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine preoperative evaluation of LV function is not recommended. | B | No benefit |
| 39 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine preoperative resting 12-lead ECG is not useful for asymptomatic patients undergoing low-risk surgical procedures. | B | No benefit |
| 40 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine screening with noninvasive stress testing is not useful for patients undergoing low-risk noncardiac surgery. | B | No benefit |
| 41 | Cardiovascular risk assessment | 2014 | ACC/AHA Guideline on the Assessment of Cardiovascular Risk | The contribution of ApoB, chronic kidney disease, albuminuria, and cardiorespiratory fitness to risk assessment for a first ASCVD event is uncertain at present. | B | No benefit |
| 42 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | AVR is not indicated in asymptomatic patients with AR who have normal LV size and function. | B | N/A |
| 43 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | AVR is not useful for prevention of sudden death in asymptomatic adults with AS who have none of the findings listed under the Class IIa/IIb indications. | B | N/A |
| 44 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Diagnostic cardiac catheterization is not indicated for uncomplicated PDA with adequate noninvasive imaging. | B | N/A |
| 45 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Endocardial pacing is not recommended in patients with CHD-PAH with persistent intravascular shunting, and alternative access for pacing leads should be sought (the risks should be individualized). | B | N/A |
| 46 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | In asymptomatic adolescents and young adults, aortic balloon valvotomy should not be performed with a peak-to-peak gradient less than 40 mm Hg without symptoms or ECG changes. | B | N/A |
| 47 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | In older adults, aortic balloon valvotomy is not recommended as an alternative to AVR, although certain younger patients may be an exception and should be referred to a center with experience in aortic balloon valvuloplasties. | B | N/A |
| 48 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | In younger patients with uncomplicated ASD for whom noninvasive imaging results are adequate, diagnostic cardiac catheterization is not indicated. | B | N/A |
| 49 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Maximal exercise testing is not recommended in ASD with severe PAH. | B | N/A |
| 50 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Maximal exercise testing is not recommended in PDA with significant PAH. | B | N/A |
| 51 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Patients with severe irreversible PAH and no evidence of a left-to-right shunt should not undergo ASD closure. | B | N/A |
| 52 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Pregnancy in women with CHD-PAH, especially those with Eisenmenger physiology, is not recommended and should be absolutely avoided in view of the high risk of maternal mortality. | B | N/A |
| 53 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Vasodilator therapy is not indicated for long-term therapy in AR for asymptomatic patients with LV systolic dysfunction who is otherwise a candidate for aortic valve replacement (AVR). | B | N/A |
| 54 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Vasodilator therapy is not indicated for long-term therapy in AR for asymptomatic patients with only mild to moderate AR and normal LV function. | B | N/A |
| 55 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | VSD closure is not recommended in patients with severe irreversible PAH. | B | N/A |
| 56 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Fibrinolytic therapy should not be administered to patients who present greater than 24 hours after the onset of symptoms. | B | N/A |
| 57 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Following STEMI, routine consultation with a cardiologist or another physician is not recommended except in equivocal or uncertain cases. Consultation delays therapy and is associated with increased hospital mortality rates. | B | N/A |
| 58 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Electric pacing is not recommended for routine use in cardiac arrest. | B | N/A |
| 59 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Fibrinolytic therapy should not be routinely used in cardiac arrest. | B | N/A |
| 60 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Procainamide and sotalol should be avoided in patients with wide-complex tachycardia and prolonged QT. If one of these antiarrhythmic agents is given, a second agent should not be given without expert consultation. | B | N/A |
| 61 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Routine administration of calcium for treatment of in-hospital and out-of-hospital cardiac arrest is not recommended. | B | N/A |
| 62 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Routine use of sodium bicarbonate is not recommended for patients in cardiac arrest. | B | N/A |
| 63 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Verapamil is contraindicated for wide-complex tachycardias unless known to be of supraventricular origin. | B | N/A |
| 64 | CPR - Adult BLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Basic Life Support | Cricoid pressure might be used in a few special circumstances (eg, to aid in viewing the vocal cords during tracheal intubation). However, the routine use of cricoid pressure in adult cardiac arrest is not recommended. | B | N/A |
| 65 | CPR - Adult BLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Basic Life Support | Excessive ventilation can be harmful in rescue breathing because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival. Rescuers should avoid excessive ventilation (too many breaths or too large a volume) during CPR. | B | N/A |
| 66 | CPR - Adult BLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Basic Life Support | Excessive ventilation in rescue breathing is unnecessary and can cause gastric inflation and its resultant complications, such as regurgitation and aspiration. | B | N/A |
| 67 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | The administration of flumazenil to patients with undifferentiated coma confers risk and is not recommended. | B | N/A |
| 68 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | Unnecessary cervical spine immobilization can impede adequate opening of the airway and delay delivery of rescue breaths. Routine stabilization of the cervical spine in the absence of circumstances that suggest a spinal injury is not recommended. | B | N/A |
| 69 | CPR - Electrical therapies | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Electrical Therapies Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing | It is not useful to shock asystole. | B | N/A |
| 70 | CPR - Electrical therapies | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Electrical Therapies Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing | Pacing is not effective for asystolic cardiac arrest and may delay or interrupt the delivery of chest compressions. Pacing for patients in asystole is not recommended. | B | N/A |
| 71 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Avoid excessive cricoid pressure so as not to obstruct the trachea. | B | N/A |
| 72 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Calcium Calcium administration is not recommended for pediatric cardiopulmonary arrest in the absence of documented hypocalcemia, calcium channel blocker overdose, hypermagnesemia, or hyperkalemia. | B | N/A |
| 73 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | In septic shock, etomidate has been shown to facilitate endotracheal intubation in infants and children with minimal hemodynamic effect, but do not use it routinely in pediatric patients with evidence of septic shock. | B | N/A |
| 74 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Routine use of sodium bicarbonate is not recommended for patients in cardiac arrest. | B | N/A |
| 75 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | There is no survival benefit from high-dose epinephrine in asystole/PEA, and it may be harmful, particularly in asphyxia. | B | N/A |
| 76 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | Attempts to control glucose concentration within a lower range (80 to 110 mg/dL [4.4 to 6.1 mmol/L]) should not be implemented after cardiac arrest due to the increased risk of hypoglycemia. | B | N/A |
| 77 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | The routine use of any serum or CSF biomarker as a sole predictor of poor outcome in comatose patients after cardiac arrest is not recommended. | B | N/A |
| 78 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | Individuals found to be at low risk (<10% 10-year risk) or at high risk (>20% 10-year risk) do not benefit from coronary calcium assessment | B | N/A |
| 79 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | Serial imaging for assessment of progression of coronary calcification is not indicated at this time | B | N/A |
| 80 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | CRT is not indicated for asymptomatic patients with reduced LVEF in the absence of other indications for pacing. | B | N/A |
| 81 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for patients with ventricular tachyarrhythmias due to a completely reversible disorder in the absence of structural heart disease (e.g., electrolyte imbalance, drugs, or trauma). | B | N/A |
| 82 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic first-degree AV block. | B | N/A |
| 83 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for AV block that is expected to resolve and is unlikely to recur (e.g., drug toxicity, Lyme disease, or transient increases in vagal tone or during hypoxia in sleep apnea syndrome in the absence of symptoms). | B | N/A |
| 84 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for fascicular block with first-degree AV block without symptoms | B | N/A |
| 85 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for fascicular block without AV block or symptoms | B | N/A |
| 86 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for transient postoperative AV block with return of normal AV conduction in the otherwise asymptomatic patient. | B | N/A |
| 87 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for the prevention of AF in patients without any other indication for pacemaker implantation. | B | N/A |
| 88 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent ventricular pacing is not indicated for new bundle-branch block or fascicular block in the absence of AV block. | B | N/A |
| 89 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent ventricular pacing is not indicated for persistent asymptomatic first-degree AV block in the presence of bundle-branch or fascicular block. | B | N/A |
| 90 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent ventricular pacing is not indicated for transient AV block in the absence of intraventricular conduction defects. | B | N/A |
| 91 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent ventricular pacing is not indicated for transient AV block in the presence of isolated left anterior fascicular block. | B | N/A |
| 92 | Device-based therapy (Update) | 2012 | ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | CRT is not recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with QRS duration less than 150 ms. | B | N/A |
| 93 | Diagnosis and treatment of infective endocarditis | 2005 | Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications | Until further definitive data are available, the routine use of aspirin for established endocarditis is not recommended. | B | N/A |
| 94 | Diagnosis and treatment of infective endocarditis | 2005 | Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications | Administration of clindamycin to treat infective endocarditis is associated with an unacceptable rate of relapse, and clindamycin use is not routinely recommended. | B | N/A |
| 95 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | BAS should not be used in individuals with baseline fasting triglyceride levels ≥300 mg/dL or type III hyperlipoproteinemia, because severe triglyceride elevations might occur. (A fasting lipid panel should be obtained before BAS is initiated, 3 months after initiation, and every 6 to 12 months thereafter.) | B | Harm |
| 96 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | Fenofibrate should not be used if moderate or severe renal impairment, defined as eGFR <30 mL/min per 1.73 m2, is present. If eGFR is between 30 and 59 mL/min per 1.73 m2, the dose of fenofibrate should not exceed 54 mg/day. If, during follow-up, the eGFR decreases persistently to ≤30 mL/min per 1.73 m2, fenofibrate should be discontinued. | B | Harm |
| 97 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | Gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. | B | Harm |
| 98 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | Niacin should not be used if patients develop either hepatic transaminase elevations higher than 2 to 3 times ULN, persistent severe cutaneous symptoms, persistent hyperglycemia, acute gout or unexplained abdominal pain or gastrointestinal symptoms, or new-onset atrial fibrillation or weight loss. | B | Harm |
| 99 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Consistent with NKF/KDOQI guidelines, given the risks of pharmacological therapy to raise HDL (in the absence of high LDL or high triglycerides), it is not recommended to initiate such therapy in patients with kidney disease. | B | N/A |
| 100 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | It is not recommended that routine prophylactic coronary revascularization be performed in patients with stable CAD, absent symptomatic or survival indications, before transplantation surgery. | B | N/A |
| 101 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Lipid-lowering therapy specifically for the goals of preventing acute rejection or preserving allograft function is not recommended. | B | N/A |
| 102 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Transplantation surgery is not recommended within 4 weeks of coronary revascularization with balloon angioplasty. | B | N/A |
| 103 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Transplantation surgery within 3 months of BMS placement and within 12 months of DES placement is not recommended, particularly if the anticipated time of poststent dual antiplatelet therapy will be shortened. | B | N/A |
| 104 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Administration of clopidogrel in combination with aspirin is not recommended within 3 months after stroke or TIA. | B | No benefit |
| 105 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Full-intensity parenteral anticoagulation with unfractionated heparin or low-molecular-weight heparinoids is not recommended for patients with atherosclerotic ECVD who develop TIA or acute ischemic stroke. | B | No benefit |
| 106 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for isolated CHD in a relative other than first or second degree. | B | N/A |
| 107 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for maternal gestational DM with HbA1c <6% or isolated CHD in a relative other than first or second degree. | B | N/A |
| 108 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for vitamin K agonists (although fetal survey is recommended). | B | N/A |
| 109 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Fetal medical therapy is of no benefit for fetuses with intermittent SVT without fetal compromise or hydrops, or intermittent VT < 200 bpm (accelerated ventricular rhythm) without fetal compromise or hydrops fetalis. | B | N/A |
| 110 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Specialized delivery room care is not needed for fetuses with shunt lesions, most ductal-dependent lesions, or controlled arrhythmias. | B | N/A |
| 111 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | Do not administer syrup of ipecac for ingestions of toxins. | B | N/A |
| 112 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | During thermal burns, do not apply ice directly to a burn; it can produce tissue ischemia | B | N/A |
| 113 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Anticoagulation is not recommended in patients with chronic HFrEF without AF, a prior thromboembolic event, or a cardioembolic source. | B | No benefit |
| 114 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | CRT is not recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with a QRS duration of less than 150 ms. | B | No benefit |
| 115 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Drugs known to adversely affect the clinical status of patients with current or prior symptoms of HFrEF 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). | B | Harm |
| 116 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is greater than 2.5 mg/dL in men or greater than 2.0 mg/dL in women (or estimated glomerular filtration rate <30 mL/min/1.73 m2), and/or potassium greater than 5.0 mEq/L. | B | Harm |
| 117 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | 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 HF. | B | Harm |
| 118 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Nutritional supplements as treatment for HF are not recommended in patients with current or prior symptoms of HFrEF. | B | No benefit |
| 119 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should not be performed. | B | No benefit |
| 120 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Routine use of invasive hemodynamic monitoring is not recommended in normotensive patients with acute decompensated HF and congestion with symptomatic response to diuretics and vasodilators. | B | No benefit |
| 121 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Use of parenteral inotropes in normotensive patients with acute decompensated HF without evidence of decreased organ perfusion is not recommended. | B | Harm |
| 122 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | 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. | B | Harm |
| 123 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Retransplantation is not efficacious when performed during the first 6 months after primary transplantation. | B | N/A |
| 124 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Retransplantation should not be performed during an episode of ongoing acute allograft rejection, even in the presence of graft vasculopathy. | B | N/A |
| 125 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | The limited supply of pediatric donors, especially infant donors, makes heart transplantation not a feasible standard therapy for any specific congenital heart lesion. | B | N/A |
| 126 | Hypertension in CAD | 2015 | Treatment of Hypertension in Patients with Coronary Artery Disease | Drugs to avoid in patients with hypertension and HF with reduced ejection fraction are nondihydropyridine CCBs (such as verapamil and diltiazem), clonidine, moxonidine, and hydralazine without a nitrate. | B | Harm |
| 127 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Genetic testing is not indicated in relatives when the index patient does not have a definitive pathogenic mutation. | B | No benefit |
| 128 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Ongoing clinical screening is not indicated in genotype-negative relatives in families with HCM. | B | No benefit |
| 129 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Digitalis is potentially harmful in the treatment of dyspnea in patients with HCM and in the absence of AF. | B | Harm |
| 130 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Dopamine, dobutamine, norepinephrine, and other intravenous positive inotropic drugs are potentially harmful for the treatment of acute hypotension in patients with obstructive HCM. | B | Harm |
| 131 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Permanent pacemaker implantation should not be performed as a first-line therapy to relieve symptoms in medically refractory symptomatic patients with HCM and LVOT obstruction who are candidates for septal reduction. | B | No benefit |
| 132 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | The use of disopyramide alone without beta blockers or verapamil is potentially harmful in the treatment of symptoms (angina or dyspnea) in patients with HCM with AF because disopyramide may enhance atrioventricular conduction and increase the ventricular rate during episodes of AF. | B | Harm |
| 133 | Infective endocarditis (Update) | 2008 | ACC/AHA Guideline Update on Valvular Heart Disease Focused Update on Infective Endocarditis | Prophylaxis against infective endocarditis is not recommended for nondental procedures (such as transesophageal echocardiogram, esophagogastroduodenoscopy, or colonoscopy) in the absence of active infection. | B | N/A |
| 134 | Ionizing radiation in cardiac imaging | 2009 | AHA Science Advisory on Ionizing Radiation in Cardiac Imaging | Longitudinal tracking of individual cumulative lifetime dose for patients is currently not practical. The modeling required to individualize dose is very complex and difficult to achieve, and the necessary tools and information systems to accomplish this for different imaging modalities are currently not available. The usefulness and societal value of such an undertaking are uncertain. | B | N/A |
| 135 | Ionizing radiation in cardiac imaging | 2009 | AHA Science Advisory on Ionizing Radiation in Cardiac Imaging | Routine surveillance radionuclide stress tests or cardiac CTs in asymptomatic patients at low risk for ischemic heart disease are not recommended. | B | N/A |
| 136 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | A strategy of routine blood transfusion in hemodynamically stable patients with NSTE-ACS and hemoglobin levels greater than 8 g/dL is not recommended. | B | No benefit |
| 137 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Administration of intravenous beta blockers is potentially harmful in patients with NSTE-ACS who have risk factors for shock. | B | Harm |
| 138 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | An early invasive strategy (ie, diagnostic angiography with intent to perform revascularization) is not recommended especially in women with acute chest pain and a low likelihood of ACS who are troponin-negative. | B | No benefit |
| 139 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Fondaparinux should not be used as the sole anticoagulant to support PCI in patients with NSTE-ACS due to an increased risk of catheter thrombosis. | B | Harm |
| 140 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Immediate-release nifedipine should not be administered to patients with NSTE-ACS in the absence of beta-blocker therapy. | B | Harm |
| 141 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Nitrates should not be administered to patients with NSTE-ACS who recently received a phosphodiesterase inhibitor, especially within 24 hours of sildenafil or vardenafil, or within 48 hours of tadalafil. | B | Harm |
| 142 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Nonsteroidal anti-inflammatory drugs (NSAIDs) (except aspirin) should not be initiated and should be discontinued during hospitalization for NSTE-ACS because of the increased risk of MACE associated with their use. | B | Harm |
| 143 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | NSAIDs with increasing degrees of relative COX-2 selectivity should not be administered to patients with NSTE-ACS and chronic musculoskeletal discomfort when therapy with acetaminophen, nonacetylated salicylates, tramadol, small doses of narcotics, or nonselective NSAIDs provide acceptable pain relief. | B | Harm |
| 144 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Prasugrel should not be administered to patients with a prior history of stroke or transient ischemic attack. | B | Harm |
| 145 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Women with NSTE-ACS and low-risk features should not undergo early invasive treatment because of the lack of benefit and the possibility of harm. | B | No benefit |
| 146 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | DES should not be implanted if the patient is not likely to be able to tolerate and comply with prolonged DAPT or this cannot be determined before stent implantation. | B | Harm |
| 147 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Elective noncardiac surgery should not be performed in the 4 to 6 weeks after balloon angioplasty or BMS implantation or the 12 months after DES implantation in patients in whom the P2Y12 inhibitor will need to be discontinued perioperatively. | B | Harm |
| 148 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI of a totally occluded infarct artery greater than 24 hours after STEMI should not be performed in asymptomatic patients with 1- or 2-vessel disease if patients are hemodynamically and electrically stable and do not have evidence of severe ischemia. | B | No benefit |
| 149 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI should not be performed in a noninfarct artery at the time of primary PCI in patients with STEMI without hemodynamic compromise. | B | Harm |
| 150 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI to improve survival should not be performed in stable patients with significant (≥50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG. | B | Harm |
| 151 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI with coronary stenting should not be performed if the patient is not likely to be able to tolerate and comply with DAPT. | B | Harm |
| 152 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Routine precatheterization laboratory (eg, ambulance or emergency room) administration of GP IIb/IIIa inhibitors as part of an upstream strategy for patients with STEMI undergoing PCI is not beneficial. | B | No benefit |
| 153 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Routine prophylactic coronary revascularization should not be performed in patients with stable CAD before noncardiac surgery. | B | Harm |
| 154 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | The routine use of vascular closure devices is not recommended for the purpose of decreasing vascular complications, including bleeding. | B | No benefit |
| 155 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | UFH should not be given to patients already receiving therapeutic subcutaneous enoxaparin. | B | Harm |
| 156 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Axillofemoral-femoral bypass should not be used for the surgical treatment of patients with intermittent claudication except in very limited settings. | B | N/A |
| 157 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Plasma renin activity is not recommended as a useful screening test to establish the diagnosis of RAS. | B | N/A |
| 158 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Surgical revascularization is not indicated for patients with asymptomatic intestinal arterial obstructions, except in patients undergoing aortic/renal artery surgery for other indications. | B | N/A |
| 159 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Oral iloprost is not an effective therapy to reduce the risk of amputation or death in patients with CLI. | B | N/A |
| 160 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Parenteral administration of pentoxifylline is not useful for the treatment of CLI. | B | N/A |
| 161 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Patients with acute limb ischemia and a nonviable extremity should not undergo an evaluation to define vascular anatomy or efforts to attempt revascularization. | B | N/A |
| 162 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Selective renal vein renin measurements are not recommended as a useful screening test to establish the diagnosis of RAS. | B | N/A |
| 163 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Surgical intervention is not indicated to prevent progression to limb-threatening ischemia in patients with intermittent claudication. | B | N/A |
| 164 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | The captopril test (measurement of plasma renin activity after captopril administration) is not recommended as a useful screening test to establish the diagnosis of RAS. | B | N/A |
| 165 | Peripheral arterial disease (Update) | 2011 | ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease | Anticoagulation therapy should not be used with antiplatelet therapy for prevention of cardiovascular events among patients with PAD. | B | N/A |
| 166 | Prevention of infective endocarditis | 2008 | AHA Guideline for the Prevention of Infective Endocarditis | The administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo GU or GI tract procedures, including diagnostic esophagogastroduodenoscopy or colonoscopy. | B | N/A |
| 167 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Aspirin is not useful for preventing a first stroke in persons with diabetes or diabetes plus asymptomatic peripheral artery disease (defined as an ankle brachial pressure index <0.99) in the absence of other established CVD. | B | N/A |
| 168 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Low-dose aspirin (81 mg/d) is not indicated for primary stroke prevention in persons who are persistently aPL positive. | B | N/A |
| 169 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | MRI and MRA criteria for selection of children for primary stroke prevention using transfusion have not been established, and these tests are not recommended in place of TCD for this purpose. | B | N/A |
| 170 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Population screening for asymptomatic carotid artery stenosis is not recommended. | B | N/A |
| 171 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | The addition of a fibrate to a statin in persons with diabetes is not useful for decreasing stroke risk. | B | N/A |
| 172 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Certain antimicrobials are not recommended for treatment of group A streptococcal upper respiratory tract infections. Tetracyclines should not be used because of the high prevalence of resistant strains. | B | N/A |
| 173 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Diagnosis of streptococcal infections using a clinical algorithm without microbiological confirmation could result in the receipt of inappropriate antimicrobial therapy by an unacceptably large number of adults with nonstreptococcal pharyngitis and is not recommended. | B | N/A |
| 174 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Older fluoroquinolones (eg, ciprofloxacin) have limited activity against GAS and should not be used to treat GAS pharyngitis. Newer fluoroquinolones (eg, levofloxacin, moxifloxacin) are active in vitro against GAS but are expensive and have an unnecessarily broad spectrum of activity, and therefore, they are not recommended for routine treatment of GAS pharyngitis. | B | N/A |
| 175 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Streptococcal Antibody Tests A commercially available slide agglutination test for the detection of antibodies to several streptococcal antigens is the Streptozyme test (Wampole Laboratories, Stamford, Conn). This test is less well standardized and less reproducible than other antibody tests, and it should not be used as a test for evidence of a preceding GAS infection. | B | N/A |
| 176 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Studies suggesting that β-lactamase–producing upper respiratory tract flora may interfere with penicillin in the treatment of GAS pharyngitis have not been confirmed. Antibiotic therapy directed against these organisms remains controversial and is not indicated in patients with acute pharyngitis. | B | N/A |
| 177 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Sulfonamides and trimethoprim-sulfamethoxazole do not eradicate GAS in patients with pharyngitis and should not be used to treat active infections. | B | N/A |
| 178 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Until carefully designed and well-controlled studies have established a causal relationship between Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) and GAS infections, the committee does not recommend routine laboratory testing for GAS to diagnose, long-term antistreptococcal prophylaxis to prevent, or immunoregulatory therapy (eg, intravenous immunoglobulin, plasma exchange) to treat exacerbations of this disorder. | B | N/A |
| 179 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Genotype testing for CHD risk assessment in asymptomatic adults is not recommended. | B | No benefit |
| 180 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | In asymptomatic high-risk adults, measurement of CRP is not recommended for cardiovascular risk assessment. | B | No benefit |
| 181 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | In low-risk men younger than 50 years of age or women 60 years of age or younger, measurement of CRP is not recommended for cardiovascular risk assessment. | B | No benefit |
| 182 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Measurement of natriuretic peptides is not recommended for CHD risk assessment in asymptomatic adults. | B | No benefit |
| 183 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Peripheral arterial flow-mediated dilation studies are not recommended for cardiovascular risk assessment in asymptomatic adults. | B | No benefit |
| 184 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Persons at low risk (<6% 10-year risk) should not undergo CAC measurement for cardiovascular risk assessment. | B | No benefit |
| 185 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Discontinuation of statin therapy is not recommended before or after CABG unless patients have adverse reactions to therapy. | B | N/A |
| 186 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Routine ACE inhibitor therapy is not recommended early after CABG among patients who do not have a history of recent MI, LV dysfunction, diabetes mellitus, or chronic kidney disease because it may lead to more harm than benefit and an unpredictable BP response. | B | N/A |
| 187 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with a stroke or TIA attributable to moderate stenosis (50%–69%) of a major intracranial artery, angioplasty or stenting is not recommended given the low rate of stroke on medical management and the inherent periprocedural risk of endovascular treatment. | B | N/A |
| 188 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with stroke or TIA attributable to 50% to 99% stenosis of a major intracranial artery, EC/IC bypass surgery is not recommended. | B | N/A |
| 189 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with stroke or TIA attributable to severe stenosis (70%–99%) of a major intracranial artery, stenting with the Wingspan stent system is not recommended as an initial treatment, even for patients who were taking an antithrombotic agent at the time of the stroke or TIA. | B | N/A |
| 190 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | In adults with a recent ischemic stroke or TIA who are known to have mild to moderate hyperhomocysteinemia, supplementation with folate, vitamin B6, and vitamin B12 safely reduces levels of homocysteine but has not been shown to prevent stroke. | B | N/A |
| 191 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Routine, long term follow-up imaging of the extracranial carotid circulation with carotid duplex ultrasonography is not recommended. | B | N/A |
| 192 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Nitrates should not be administered to patients within 24 hours of sildenafil or vardenafil administration or within 48 hours of tadalafil administration. | B | N/A |
| 193 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | PDE5 inhibitors should not be used in patients receiving nitrate therapy. | B | N/A |
| 194 | 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 | CABG or PCI should not be performed with the primary or sole intent to improve survival in patients with SIHD with 1 or more coronary stenoses that are not anatomically or functionally significant (eg, <70% diameter non–left main coronary artery stenosis, FFR >0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium. | B | Harm |
| 195 | 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 | CCTA should not be performed for assessment of native coronary arteries with known moderate or severe calcification or with coronary stents less than 3 mm in diameter in patients with known SIHD who have new or worsening symptoms not consistent with UA, irrespective of ability to exercise. | B | No benefit |
| 196 | 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 | Coronary angiography for risk assessment is not recommended in patients with SIHD who elect not to undergo revascularization or who are not candidates for revascularization because of comorbidities or individual preferences. | B | No benefit |
| 197 | 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 | Coronary angiography is not recommended to further assess risk in patients with SIHD who have preserved LV function (EF >50%) and low-risk criteria on noninvasive testing. | B | No benefit |
| 198 | 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 | Dipyridamole is not recommended as antiplatelet therapy for patients with SIHD. | B | No benefit |
| 199 | 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 | PCI to improve survival should not be performed in stable patients with significant (≥50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG. | B | Harm |
| 200 | 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 | PCI with coronary stenting (bare-metal stent or drug-eluting stent) should not be performed if the patient is not likely to be able to tolerate and comply with dual antiplatelet therapy for the appropriate duration of treatment based on the type of stent implanted. | B | Harm |
| 201 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Delayed PCI of a totally occluded infarct artery greater than 24 hours after STEMI should not be performed in asymptomatic patients with 1- or 2-vessel disease if they are hemodynamically and electrically stable and do not have evidence of severe ischemia | B | No benefit |
| 202 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | DES should not be used in primary PCI for patients with STEMI who are unable to tolerate or comply with a prolonged course of DAPT because of the increased risk of stent thrombosis with premature discontinuation of one or both agents. | B | Harm |
| 203 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Fibrinolytic therapy should not be administered to patients with ST depression except when a true posterior (inferobasal) MI is suspected or when associated with ST elevation in lead aVR. | B | Harm |
| 204 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Fondaparinux should not be used as the sole anticoagulant to support primary PCI because of the risk of catheter thrombosis. | B | Harm |
| 205 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Glucocorticoids and nonsteroidal anti-inflammatory drugs are potentially harmful for treatment of pericarditis after STEMI | B | Harm |
| 206 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | PCI should not be performed in a noninfarct artery at the time of primary PCI in patients with STEMI who are hemodynamically stable. | B | Harm |
| 207 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Prasugrel should not be administered to patients with a history of prior stroke or transient ischemic attack. | B | Harm |
| 208 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Atenolol is not indicated as prophylactic therapy for patients with SVT during pregnancy. | B | N/A |
| 209 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Verapamil is not indicated among patients with wide QRS-complex tachycardia of unknown origin. | B | N/A |
| 210 | Thoracic aortic disease | 2010 | ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease | Furosemide, mannitol, or dopamine should not be given solely for the purpose of renal protection in descending aortic repairs. | B | N/A |
| 211 | Thoracic aortic disease | 2010 | ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease | Perioperative brain hyperthermia is not recommended in repairs of the ascending aortic and transverse aortic arch as it is probably injurious to the brain. | B | N/A |
| 212 | Thoracic aortic disease | 2010 | ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease | Furosemide, mannitol, or dopamine should not be given solely for the purpose of renal protection in descending aortic repairs. | B | N/A |
| 213 | Thoracic aortic disease | 2010 | ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease | Perioperative brain hyperthermia is not recommended in repairs of the ascending aortic and transverse aortic arch as it is probably injurious to the brain. | B | N/A |
| 214 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | ACE inhibitors and ARBs should not be given to pregnant patients with valve regurgitation. | B | Harm |
| 215 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | ACE inhibitors and ARBs should not be given to pregnant patients with valve stenosis. | B | Harm |
| 216 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Anticoagulant therapy with oral direct thrombin inhibitors or anti-Xa agents should not be used in patients with mechanical valve prostheses. | B | Harm |
| 217 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Catheter ablation for AF should not be performed in patients with severe MR when mitral repair or replacement is anticipated, with preference for the combined maze procedure plus mitral valve repair. | B | No benefit |
| 218 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Exercise testing should not be performed in symptomatic patients with AS when the aortic velocity is 4.0 m per second or greater or mean pressure gradient is 40 mm Hg or higher (stage D). | B | Harm |
| 219 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | LMWH should not be administered to pregnant patients with mechanical prostheses unless antiXa levels are monitored 4 to 6 hours after administration. | B | Harm |
| 220 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | MVR should not be performed for the treatment of isolated severe primary MR limited to less than one half of the posterior leaflet unless mitral valve repair has been attempted and was unsuccessful. | B | Harm |
| 221 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Prophylaxis against IE is not recommended in patients with VHD who are at risk of IE for nondental procedures (e.g., TEE, esophagogastroduodenoscopy, colonoscopy, or cystoscopy) in the absence of active infection. | B | No benefit |
| 222 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | TAVR is not recommended in patients in whom existing comorbidities would preclude the expected benefit from correction of AS. | B | No benefit |
| 223 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Vasodilator therapy is not indicated for normotensive asymptomatic patients with chronic primary MR (stages B and C1) and normal systolic LV function. | B | No benefit |
| 224 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Prophylactic antiarrhythmic drug therapy is not indicated to reduce mortality in patients with asymptomatic nonsustained ventricular arrhythmias. | B | No benefit |
| 225 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | An IVC filter should not be used routinely in the treatment of IFDVT. | B | N/A |
| 226 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | CDT or PCDT should not be given to most patients with chronic DVT symptoms (>21 days) or patients who are at high risk for bleeding complications. | B | N/A |
| 227 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | Fibrinolysis is not recommended for patients with low-risk PE or submassive acute PE with minor RV dysfunction, minor myocardial necrosis, and no clinical worsening. | B | N/A |
| 228 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | Fibrinolysis is not recommended for undifferentiated cardiac arrest. | B | N/A |
| 229 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | PAH (WHO Group I)-specific medical therapy should not be used in lieu of pulmonary endarterectomy or delay evaluation for pulmonary endarterectomy for patients with objectively proven CTEPH who are or may be surgical candidates at an experienced center. | B | N/A |
Class III B Recommendations: Organized by Year of Guideline Publication
The table shown below is a list of class III B 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 | Hypertension in CAD | 2015 | Treatment of Hypertension in Patients with Coronary Artery Disease | Drugs to avoid in patients with hypertension and HF with reduced ejection fraction are nondihydropyridine CCBs (such as verapamil and diltiazem), clonidine, moxonidine, and hydralazine without a nitrate. | B | Harm |
| 2 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Discontinuation of statin therapy is not recommended before or after CABG unless patients have adverse reactions to therapy. | B | N/A |
| 3 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Routine ACE inhibitor therapy is not recommended early after CABG among patients who do not have a history of recent MI, LV dysfunction, diabetes mellitus, or chronic kidney disease because it may lead to more harm than benefit and an unpredictable BP response. | B | N/A |
| 4 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Administration of intravenous amiodarone, adenosine, digoxin (oral or intravenous), or nondihydropyridine calcium channel antagonists (oral or intravenous) in patients with Wolff-Parkinson-White syndrome who have pre-excited AF is potentially harmful because these drugs accelerate the ventricular rate. | B | Harm |
| 5 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Dofetilide therapy should not be initiated out of hospital because of the risk of excessive QT prolongation that can cause torsades de pointes. | B | Harm |
| 6 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Dronedarone should not be used for treatment of AF in patients with New York Heart Association class III and IV HF or patients who have had an episode of decompensated HF in the past 4 weeks. | B | Harm |
| 7 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Dronedarone should not be used to control the ventricular rate in patients with permanent AF as it increases the risk of the combined endpoint of stroke, myocardial infarction, systemic embolism, or cardiovascular death. | B | Harm |
| 8 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Dronedarone, in specific, for rhythm control should not be continued when AF becomes permanent. | B | Harm |
| 9 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | In patients with pre-excitation and AF, digoxin, nondihydropyridine calcium channel antagonists, or intravenous amiodarone should not be administered as they may increase the ventricular response and may result in ventricular fibrillation. | B | Harm |
| 10 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | The direct thrombin inhibitor dabigatran should not be used in patients with AF and a mechanical heart valve. | B | Harm |
| 11 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Therapy with an ACE inhibitor, ARB, or statin is not beneficial for primary prevention of AF in patients without cardiovascular disease. | B | No benefit |
| 12 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Alpha-2 agonists for prevention of cardiac events are not recommended in patients who are undergoing noncardiac surgery. | B | No benefit |
| 13 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Beta-blocker therapy should not be started on the day of surgery. | B | Harm |
| 14 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Elective noncardiac surgery should not be performed within 30 days after BMS implantation or within 12 months after DES implantation in patients in whom dual antiplatelet therapy will need to be discontinued perioperatively. | B | Harm |
| 15 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | For patients with a low risk of perioperative MACE, further testing is not recommended before the planned operation. | B | No benefit |
| 16 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | It is not recommended that routine coronary revascularization be performed before noncardiac surgery exclusively to reduce perioperative cardiac events. | B | No benefit |
| 17 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Prophylactic intravenous nitroglycerin is not effective in reducing myocardial ischemia in patients undergoing noncardiac surgery. | B | No benefit |
| 18 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine postoperative screening with troponin levels in unselected patients without signs or symptoms suggestive of myocardial ischemia or MI is not useful for guiding perioperative management. | B | No benefit |
| 19 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine preoperative evaluation of LV function is not recommended. | B | No benefit |
| 20 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine preoperative resting 12-lead ECG is not useful for asymptomatic patients undergoing low-risk surgical procedures. | B | No benefit |
| 21 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine screening with noninvasive stress testing is not useful for patients undergoing low-risk noncardiac surgery. | B | No benefit |
| 22 | Cardiovascular risk assessment | 2014 | ACC/AHA Guideline on the Assessment of Cardiovascular Risk | The contribution of ApoB, chronic kidney disease, albuminuria, and cardiorespiratory fitness to risk assessment for a first ASCVD event is uncertain at present. | B | No benefit |
| 23 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for isolated CHD in a relative other than first or second degree. | B | N/A |
| 24 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for maternal gestational DM with HbA1c <6% or isolated CHD in a relative other than first or second degree. | B | N/A |
| 25 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for vitamin K agonists (although fetal survey is recommended). | B | N/A |
| 26 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Fetal medical therapy is of no benefit for fetuses with intermittent SVT without fetal compromise or hydrops, or intermittent VT < 200 bpm (accelerated ventricular rhythm) without fetal compromise or hydrops fetalis. | B | N/A |
| 27 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Specialized delivery room care is not needed for fetuses with shunt lesions, most ductal-dependent lesions, or controlled arrhythmias. | B | N/A |
| 28 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | A strategy of routine blood transfusion in hemodynamically stable patients with NSTE-ACS and hemoglobin levels greater than 8 g/dL is not recommended. | B | No benefit |
| 29 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Administration of intravenous beta blockers is potentially harmful in patients with NSTE-ACS who have risk factors for shock. | B | Harm |
| 30 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | An early invasive strategy (ie, diagnostic angiography with intent to perform revascularization) is not recommended especially in women with acute chest pain and a low likelihood of ACS who are troponin-negative. | B | No benefit |
| 31 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Fondaparinux should not be used as the sole anticoagulant to support PCI in patients with NSTE-ACS due to an increased risk of catheter thrombosis. | B | Harm |
| 32 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Immediate-release nifedipine should not be administered to patients with NSTE-ACS in the absence of beta-blocker therapy. | B | Harm |
| 33 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Nitrates should not be administered to patients with NSTE-ACS who recently received a phosphodiesterase inhibitor, especially within 24 hours of sildenafil or vardenafil, or within 48 hours of tadalafil. | B | Harm |
| 34 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Nonsteroidal anti-inflammatory drugs (NSAIDs) (except aspirin) should not be initiated and should be discontinued during hospitalization for NSTE-ACS because of the increased risk of MACE associated with their use. | B | Harm |
| 35 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | NSAIDs with increasing degrees of relative COX-2 selectivity should not be administered to patients with NSTE-ACS and chronic musculoskeletal discomfort when therapy with acetaminophen, nonacetylated salicylates, tramadol, small doses of narcotics, or nonselective NSAIDs provide acceptable pain relief. | B | Harm |
| 36 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Prasugrel should not be administered to patients with a prior history of stroke or transient ischemic attack. | B | Harm |
| 37 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Women with NSTE-ACS and low-risk features should not undergo early invasive treatment because of the lack of benefit and the possibility of harm. | B | No benefit |
| 38 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with a stroke or TIA attributable to moderate stenosis (50%–69%) of a major intracranial artery, angioplasty or stenting is not recommended given the low rate of stroke on medical management and the inherent periprocedural risk of endovascular treatment. | B | N/A |
| 39 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with stroke or TIA attributable to 50% to 99% stenosis of a major intracranial artery, EC/IC bypass surgery is not recommended. | B | N/A |
| 40 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with stroke or TIA attributable to severe stenosis (70%–99%) of a major intracranial artery, stenting with the Wingspan stent system is not recommended as an initial treatment, even for patients who were taking an antithrombotic agent at the time of the stroke or TIA. | B | N/A |
| 41 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | In adults with a recent ischemic stroke or TIA who are known to have mild to moderate hyperhomocysteinemia, supplementation with folate, vitamin B6, and vitamin B12 safely reduces levels of homocysteine but has not been shown to prevent stroke. | B | N/A |
| 42 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Routine, long term follow-up imaging of the extracranial carotid circulation with carotid duplex ultrasonography is not recommended. | B | N/A |
| 43 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | ACE inhibitors and ARBs should not be given to pregnant patients with valve regurgitation. | B | Harm |
| 44 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | ACE inhibitors and ARBs should not be given to pregnant patients with valve stenosis. | B | Harm |
| 45 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Anticoagulant therapy with oral direct thrombin inhibitors or anti-Xa agents should not be used in patients with mechanical valve prostheses. | B | Harm |
| 46 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Catheter ablation for AF should not be performed in patients with severe MR when mitral repair or replacement is anticipated, with preference for the combined maze procedure plus mitral valve repair. | B | No benefit |
| 47 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Exercise testing should not be performed in symptomatic patients with AS when the aortic velocity is 4.0 m per second or greater or mean pressure gradient is 40 mm Hg or higher (stage D). | B | Harm |
| 48 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | LMWH should not be administered to pregnant patients with mechanical prostheses unless antiXa levels are monitored 4 to 6 hours after administration. | B | Harm |
| 49 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | MVR should not be performed for the treatment of isolated severe primary MR limited to less than one half of the posterior leaflet unless mitral valve repair has been attempted and was unsuccessful. | B | Harm |
| 50 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Prophylaxis against IE is not recommended in patients with VHD who are at risk of IE for nondental procedures (e.g., TEE, esophagogastroduodenoscopy, colonoscopy, or cystoscopy) in the absence of active infection. | B | No benefit |
| 51 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | TAVR is not recommended in patients in whom existing comorbidities would preclude the expected benefit from correction of AS. | B | No benefit |
| 52 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Vasodilator therapy is not indicated for normotensive asymptomatic patients with chronic primary MR (stages B and C1) and normal systolic LV function. | B | No benefit |
| 53 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Aspirin is not recommended as a substitute for other acute interventions for treatment of stroke, including intravenous rtPA. | B | N/A |
| 54 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Data on the utility of hyperbaric oxygen are inconclusive, and some data imply that the intervention may be harmful. Thus, with the exception of stroke secondary to air embolization, this intervention is not recommended for treatment of patients with acute ischemic stroke. | B | N/A |
| 55 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Initiation of anticoagulant therapy within 24 hours of treatment with intravenous rtPA is not recommended. | B | N/A |
| 56 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Routine use of nutritional supplements has not been shown to be beneficial. | B | N/A |
| 57 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Routine use of prophylactic antibiotics has not been shown to be beneficial. | B | N/A |
| 58 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Supplemental oxygen is not recommended in nonhypoxic patients with acute ischemic stroke. | B | N/A |
| 59 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The administration of other intravenous antiplatelet agents that inhibit the glycoprotein IIb/IIIa receptor is not recommended. | B | N/A |
| 60 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | BAS should not be used in individuals with baseline fasting triglyceride levels ≥300 mg/dL or type III hyperlipoproteinemia, because severe triglyceride elevations might occur. (A fasting lipid panel should be obtained before BAS is initiated, 3 months after initiation, and every 6 to 12 months thereafter.) | B | Harm |
| 61 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | Fenofibrate should not be used if moderate or severe renal impairment, defined as eGFR <30 mL/min per 1.73 m2, is present. If eGFR is between 30 and 59 mL/min per 1.73 m2, the dose of fenofibrate should not exceed 54 mg/day. If, during follow-up, the eGFR decreases persistently to ≤30 mL/min per 1.73 m2, fenofibrate should be discontinued. | B | Harm |
| 62 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | Gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. | B | Harm |
| 63 | Dyslipidemia | 2013 | ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults | Niacin should not be used if patients develop either hepatic transaminase elevations higher than 2 to 3 times ULN, persistent severe cutaneous symptoms, persistent hyperglycemia, acute gout or unexplained abdominal pain or gastrointestinal symptoms, or new-onset atrial fibrillation or weight loss. | B | Harm |
| 64 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Anticoagulation is not recommended in patients with chronic HFrEF without AF, a prior thromboembolic event, or a cardioembolic source. | B | No benefit |
| 65 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | CRT is not recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with a QRS duration of less than 150 ms. | B | No benefit |
| 66 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Drugs known to adversely affect the clinical status of patients with current or prior symptoms of HFrEF 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). | B | Harm |
| 67 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is greater than 2.5 mg/dL in men or greater than 2.0 mg/dL in women (or estimated glomerular filtration rate <30 mL/min/1.73 m2), and/or potassium greater than 5.0 mEq/L. | B | Harm |
| 68 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | 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 HF. | B | Harm |
| 69 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Nutritional supplements as treatment for HF are not recommended in patients with current or prior symptoms of HFrEF. | B | No benefit |
| 70 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should not be performed. | B | No benefit |
| 71 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Routine use of invasive hemodynamic monitoring is not recommended in normotensive patients with acute decompensated HF and congestion with symptomatic response to diuretics and vasodilators. | B | No benefit |
| 72 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Use of parenteral inotropes in normotensive patients with acute decompensated HF without evidence of decreased organ perfusion is not recommended. | B | Harm |
| 73 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | 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. | B | Harm |
| 74 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Delayed PCI of a totally occluded infarct artery greater than 24 hours after STEMI should not be performed in asymptomatic patients with 1- or 2-vessel disease if they are hemodynamically and electrically stable and do not have evidence of severe ischemia | B | No benefit |
| 75 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | DES should not be used in primary PCI for patients with STEMI who are unable to tolerate or comply with a prolonged course of DAPT because of the increased risk of stent thrombosis with premature discontinuation of one or both agents. | B | Harm |
| 76 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Fibrinolytic therapy should not be administered to patients with ST depression except when a true posterior (inferobasal) MI is suspected or when associated with ST elevation in lead aVR. | B | Harm |
| 77 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Fondaparinux should not be used as the sole anticoagulant to support primary PCI because of the risk of catheter thrombosis. | B | Harm |
| 78 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Glucocorticoids and nonsteroidal anti-inflammatory drugs are potentially harmful for treatment of pericarditis after STEMI | B | Harm |
| 79 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | PCI should not be performed in a noninfarct artery at the time of primary PCI in patients with STEMI who are hemodynamically stable. | B | Harm |
| 80 | STEMI | 2013 | ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction | Prasugrel should not be administered to patients with a history of prior stroke or transient ischemic attack. | B | Harm |
| 81 | Device-based therapy (Update) | 2012 | ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | CRT is not recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with QRS duration less than 150 ms. | B | N/A |
| 82 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Consistent with NKF/KDOQI guidelines, given the risks of pharmacological therapy to raise HDL (in the absence of high LDL or high triglycerides), it is not recommended to initiate such therapy in patients with kidney disease. | B | N/A |
| 83 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | It is not recommended that routine prophylactic coronary revascularization be performed in patients with stable CAD, absent symptomatic or survival indications, before transplantation surgery. | B | N/A |
| 84 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Lipid-lowering therapy specifically for the goals of preventing acute rejection or preserving allograft function is not recommended. | B | N/A |
| 85 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Transplantation surgery is not recommended within 4 weeks of coronary revascularization with balloon angioplasty. | B | N/A |
| 86 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Transplantation surgery within 3 months of BMS placement and within 12 months of DES placement is not recommended, particularly if the anticipated time of poststent dual antiplatelet therapy will be shortened. | B | N/A |
| 87 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Nitrates should not be administered to patients within 24 hours of sildenafil or vardenafil administration or within 48 hours of tadalafil administration. | B | N/A |
| 88 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | PDE5 inhibitors should not be used in patients receiving nitrate therapy. | B | N/A |
| 89 | 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 | CABG or PCI should not be performed with the primary or sole intent to improve survival in patients with SIHD with 1 or more coronary stenoses that are not anatomically or functionally significant (eg, <70% diameter non–left main coronary artery stenosis, FFR >0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium. | B | Harm |
| 90 | 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 | CCTA should not be performed for assessment of native coronary arteries with known moderate or severe calcification or with coronary stents less than 3 mm in diameter in patients with known SIHD who have new or worsening symptoms not consistent with UA, irrespective of ability to exercise. | B | No benefit |
| 91 | 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 | Coronary angiography for risk assessment is not recommended in patients with SIHD who elect not to undergo revascularization or who are not candidates for revascularization because of comorbidities or individual preferences. | B | No benefit |
| 92 | 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 | Coronary angiography is not recommended to further assess risk in patients with SIHD who have preserved LV function (EF >50%) and low-risk criteria on noninvasive testing. | B | No benefit |
| 93 | 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 | Dipyridamole is not recommended as antiplatelet therapy for patients with SIHD. | B | No benefit |
| 94 | 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 | PCI to improve survival should not be performed in stable patients with significant (≥50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG. | B | Harm |
| 95 | 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 | PCI with coronary stenting (bare-metal stent or drug-eluting stent) should not be performed if the patient is not likely to be able to tolerate and comply with dual antiplatelet therapy for the appropriate duration of treatment based on the type of stent implanted. | B | Harm |
| 96 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | CABG or PCI should not be performed with the primary or sole intent to improve survival in patients with SIHD with 1 or more coronary stenoses that are not anatomically or functionally significant (eg, <70% diameter non–left main coronary artery stenosis, fractional flow reserve >0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium. | B | Harm |
| 97 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Cyclooxygenase-2 inhibitors are not recommended for pain relief in the postoperative period after CABG. | B | Harm |
| 98 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Discontinuation of statin or other dyslipidemic therapy is not recommended before or after CABG in patients without adverse reactions to therapy. | B | Harm |
| 99 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | PCI to improve survival should not be performed in stable patients with significant (>50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG. | B | Harm |
| 100 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | PCI with coronary stenting (bare-metal stent or drug-eluting stent) should not be performed if the patient is not likely to be able to tolerate and comply with dual antiplatelet therapy for the appropriate duration of treatment based on the type of stent implanted. | B | Harm |
| 101 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Postmenopausal hormonal therapy (estrogen/prosgesterone) should not be administered to women undergoing CABG. | B | Harm |
| 102 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter secundum ASD closure is not indicated in patients with a small secundum ASD of no hemodynamic significance and with no other risk factors. | B | N/A |
| 103 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Neonates, infants, and children with a small to moderate-sized MVSD (without symptoms or evidence of pulmonary hypertension) in whom there is a reasonable expectation that the defect will become smaller over time should be followed up expectantly and do not need closure of the VSD. | B | N/A |
| 104 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Neonates, infants, and children with hemodynamically significant (left ventricular or left atrial volume overload or pulmonary-to-systemic blood flow ratio >2 1) inlet MVSDs with inadequate space between the defect and the atrioventricular or semilunar valves should not undergo device closure (hybrid or percutaneous). | B | N/A |
| 105 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Pulmonary valvuloplasty should not be performed in patients with pulmonary atresia and RV-dependent coronary circulation. | B | N/A |
| 106 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter balloon valvuloplasty is not indicated for patients with congenital mitral valve stenosis due to supramitral valve ring or associated with hypoplastic left ventricle. | B | N/A |
| 107 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Administration of clopidogrel in combination with aspirin is not recommended within 3 months after stroke or TIA. | B | No benefit |
| 108 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Full-intensity parenteral anticoagulation with unfractionated heparin or low-molecular-weight heparinoids is not recommended for patients with atherosclerotic ECVD who develop TIA or acute ischemic stroke. | B | No benefit |
| 109 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Genetic testing is not indicated in relatives when the index patient does not have a definitive pathogenic mutation. | B | No benefit |
| 110 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Ongoing clinical screening is not indicated in genotype-negative relatives in families with HCM. | B | No benefit |
| 111 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Digitalis is potentially harmful in the treatment of dyspnea in patients with HCM and in the absence of AF. | B | Harm |
| 112 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Dopamine, dobutamine, norepinephrine, and other intravenous positive inotropic drugs are potentially harmful for the treatment of acute hypotension in patients with obstructive HCM. | B | Harm |
| 113 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Permanent pacemaker implantation should not be performed as a first-line therapy to relieve symptoms in medically refractory symptomatic patients with HCM and LVOT obstruction who are candidates for septal reduction. | B | No benefit |
| 114 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | The use of disopyramide alone without beta blockers or verapamil is potentially harmful in the treatment of symptoms (angina or dyspnea) in patients with HCM with AF because disopyramide may enhance atrioventricular conduction and increase the ventricular rate during episodes of AF. | B | Harm |
| 115 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | DES should not be implanted if the patient is not likely to be able to tolerate and comply with prolonged DAPT or this cannot be determined before stent implantation. | B | Harm |
| 116 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Elective noncardiac surgery should not be performed in the 4 to 6 weeks after balloon angioplasty or BMS implantation or the 12 months after DES implantation in patients in whom the P2Y12 inhibitor will need to be discontinued perioperatively. | B | Harm |
| 117 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI of a totally occluded infarct artery greater than 24 hours after STEMI should not be performed in asymptomatic patients with 1- or 2-vessel disease if patients are hemodynamically and electrically stable and do not have evidence of severe ischemia. | B | No benefit |
| 118 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI should not be performed in a noninfarct artery at the time of primary PCI in patients with STEMI without hemodynamic compromise. | B | Harm |
| 119 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI to improve survival should not be performed in stable patients with significant (≥50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG. | B | Harm |
| 120 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI with coronary stenting should not be performed if the patient is not likely to be able to tolerate and comply with DAPT. | B | Harm |
| 121 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Routine precatheterization laboratory (eg, ambulance or emergency room) administration of GP IIb/IIIa inhibitors as part of an upstream strategy for patients with STEMI undergoing PCI is not beneficial. | B | No benefit |
| 122 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Routine prophylactic coronary revascularization should not be performed in patients with stable CAD before noncardiac surgery. | B | Harm |
| 123 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | The routine use of vascular closure devices is not recommended for the purpose of decreasing vascular complications, including bleeding. | B | No benefit |
| 124 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | UFH should not be given to patients already receiving therapeutic subcutaneous enoxaparin. | B | Harm |
| 125 | Peripheral arterial disease (Update) | 2011 | ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease | Anticoagulation therapy should not be used with antiplatelet therapy for prevention of cardiovascular events among patients with PAD. | B | N/A |
| 126 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Aspirin is not useful for preventing a first stroke in persons with diabetes or diabetes plus asymptomatic peripheral artery disease (defined as an ankle brachial pressure index <0.99) in the absence of other established CVD. | B | N/A |
| 127 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Low-dose aspirin (81 mg/d) is not indicated for primary stroke prevention in persons who are persistently aPL positive. | B | N/A |
| 128 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | MRI and MRA criteria for selection of children for primary stroke prevention using transfusion have not been established, and these tests are not recommended in place of TCD for this purpose. | B | N/A |
| 129 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Population screening for asymptomatic carotid artery stenosis is not recommended. | B | N/A |
| 130 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | The addition of a fibrate to a statin in persons with diabetes is not useful for decreasing stroke risk. | B | N/A |
| 131 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | An IVC filter should not be used routinely in the treatment of IFDVT. | B | N/A |
| 132 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | CDT or PCDT should not be given to most patients with chronic DVT symptoms (>21 days) or patients who are at high risk for bleeding complications. | B | N/A |
| 133 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | Fibrinolysis is not recommended for patients with low-risk PE or submassive acute PE with minor RV dysfunction, minor myocardial necrosis, and no clinical worsening. | B | N/A |
| 134 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | Fibrinolysis is not recommended for undifferentiated cardiac arrest. | B | N/A |
| 135 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | PAH (WHO Group I)-specific medical therapy should not be used in lieu of pulmonary endarterectomy or delay evaluation for pulmonary endarterectomy for patients with objectively proven CTEPH who are or may be surgical candidates at an experienced center. | B | N/A |
| 136 | Arteriotomy closure devices | 2010 | Arteriotomy Closure Devices for Cardiovascular Procedures | ACDs should not be used routinely for the specific purpose of reducing vascular complications in patients undergoing invasive cardiovascular procedures via the femoral artery approach. | B | N/A |
| 137 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Fibrinolytic therapy should not be administered to patients who present greater than 24 hours after the onset of symptoms. | B | N/A |
| 138 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Following STEMI, routine consultation with a cardiologist or another physician is not recommended except in equivocal or uncertain cases. Consultation delays therapy and is associated with increased hospital mortality rates. | B | N/A |
| 139 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Electric pacing is not recommended for routine use in cardiac arrest. | B | N/A |
| 140 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Fibrinolytic therapy should not be routinely used in cardiac arrest. | B | N/A |
| 141 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Procainamide and sotalol should be avoided in patients with wide-complex tachycardia and prolonged QT. If one of these antiarrhythmic agents is given, a second agent should not be given without expert consultation. | B | N/A |
| 142 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Routine administration of calcium for treatment of in-hospital and out-of-hospital cardiac arrest is not recommended. | B | N/A |
| 143 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Routine use of sodium bicarbonate is not recommended for patients in cardiac arrest. | B | N/A |
| 144 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Verapamil is contraindicated for wide-complex tachycardias unless known to be of supraventricular origin. | B | N/A |
| 145 | CPR - Adult BLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Basic Life Support | Cricoid pressure might be used in a few special circumstances (eg, to aid in viewing the vocal cords during tracheal intubation). However, the routine use of cricoid pressure in adult cardiac arrest is not recommended. | B | N/A |
| 146 | CPR - Adult BLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Basic Life Support | Excessive ventilation can be harmful in rescue breathing because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival. Rescuers should avoid excessive ventilation (too many breaths or too large a volume) during CPR. | B | N/A |
| 147 | CPR - Adult BLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Basic Life Support | Excessive ventilation in rescue breathing is unnecessary and can cause gastric inflation and its resultant complications, such as regurgitation and aspiration. | B | N/A |
| 148 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | The administration of flumazenil to patients with undifferentiated coma confers risk and is not recommended. | B | N/A |
| 149 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | Unnecessary cervical spine immobilization can impede adequate opening of the airway and delay delivery of rescue breaths. Routine stabilization of the cervical spine in the absence of circumstances that suggest a spinal injury is not recommended. | B | N/A |
| 150 | CPR - Electrical therapies | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Electrical Therapies Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing | It is not useful to shock asystole. | B | N/A |
| 151 | CPR - Electrical therapies | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Electrical Therapies Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing | Pacing Pacing is not effective for asystolic cardiac arrest and may delay or interrupt the delivery of chest compressions. Pacing for patients in asystole is not recommended. | B | N/A |
| 152 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Avoid excessive cricoid pressure so as not to obstruct the trachea. | B | N/A |
| 153 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Calcium Calcium administration is not recommended for pediatric cardiopulmonary arrest in the absence of documented hypocalcemia, calcium channel blocker overdose, hypermagnesemia, or hyperkalemia. | B | N/A |
| 154 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | In septic shock, etomidate has been shown to facilitate endotracheal intubation in infants and children with minimal hemodynamic effect, but do not use it routinely in pediatric patients with evidence of septic shock. | B | N/A |
| 155 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Routine use of sodium bicarbonate is not recommended for patients in cardiac arrest. | B | N/A |
| 156 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | There is no survival benefit from high-dose epinephrine in asystole/PEA, and it may be harmful, particularly in asphyxia. | B | N/A |
| 157 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | Attempts to control glucose concentration within a lower range (80 to 110 mg/dL [4.4 to 6.1 mmol/L]) should not be implemented after cardiac arrest due to the increased risk of hypoglycemia. | B | N/A |
| 158 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | The routine use of any serum or CSF biomarker as a sole predictor of poor outcome in comatose patients after cardiac arrest is not recommended. | B | N/A |
| 159 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | Do not administer syrup of ipecac for ingestions of toxins. | B | N/A |
| 160 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | During thermal burns, do not apply ice directly to a burn; it can produce tissue ischemia | B | N/A |
| 161 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Genotype testing for CHD risk assessment in asymptomatic adults is not recommended. | B | No benefit |
| 162 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | In asymptomatic high-risk adults, measurement of CRP is not recommended for cardiovascular risk assessment. | B | No benefit |
| 163 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | In low-risk men younger than 50 years of age or women 60 years of age or younger, measurement of CRP is not recommended for cardiovascular risk assessment. | B | No benefit |
| 164 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Measurement of natriuretic peptides is not recommended for CHD risk assessment in asymptomatic adults. | B | No benefit |
| 165 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Peripheral arterial flow-mediated dilation studies are not recommended for cardiovascular risk assessment in asymptomatic adults. | B | No benefit |
| 166 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Persons at low risk (<6% 10-year risk) should not undergo CAC measurement for cardiovascular risk assessment. | B | No benefit |
| 167 | Thoracic aortic disease | 2010 | ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease | Furosemide, mannitol, or dopamine should not be given solely for the purpose of renal protection in descending aortic repairs. | B | N/A |
| 168 | Thoracic aortic disease | 2010 | ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease | Perioperative brain hyperthermia is not recommended in repairs of the ascending aortic and transverse aortic arch as it is probably injurious to the brain. | B | N/A |
| 169 | Thoracic aortic disease | 2010 | ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease | Furosemide, mannitol, or dopamine should not be given solely for the purpose of renal protection in descending aortic repairs. | B | N/A |
| 170 | Thoracic aortic disease | 2010 | ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease | Perioperative brain hyperthermia is not recommended in repairs of the ascending aortic and transverse aortic arch as it is probably injurious to the brain. | B | N/A |
| 171 | Ionizing radiation in cardiac imaging | 2009 | AHA Science Advisory on Ionizing Radiation in Cardiac Imaging | Longitudinal tracking of individual cumulative lifetime dose for patients is currently not practical. The modeling required to individualize dose is very complex and difficult to achieve, and the necessary tools and information systems to accomplish this for different imaging modalities are currently not available. The usefulness and societal value of such an undertaking are uncertain. | B | N/A |
| 172 | Ionizing radiation in cardiac imaging | 2009 | AHA Science Advisory on Ionizing Radiation in Cardiac Imaging | Routine surveillance radionuclide stress tests or cardiac CTs in asymptomatic patients at low risk for ischemic heart disease are not recommended. | B | N/A |
| 173 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Certain antimicrobials are not recommended for treatment of group A streptococcal upper respiratory tract infections. Tetracyclines should not be used because of the high prevalence of resistant strains. | B | N/A |
| 174 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Diagnosis of streptococcal infections using a clinical algorithm without microbiological confirmation could result in the receipt of inappropriate antimicrobial therapy by an unacceptably large number of adults with nonstreptococcal pharyngitis and is not recommended. | B | N/A |
| 175 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Older fluoroquinolones (eg, ciprofloxacin) have limited activity against GAS and should not be used to treat GAS pharyngitis. Newer fluoroquinolones (eg, levofloxacin, moxifloxacin) are active in vitro against GAS but are expensive and have an unnecessarily broad spectrum of activity, and therefore, they are not recommended for routine treatment of GAS pharyngitis. | B | N/A |
| 176 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Streptococcal Antibody Tests A commercially available slide agglutination test for the detection of antibodies to several streptococcal antigens is the Streptozyme test (Wampole Laboratories, Stamford, Conn). This test is less well standardized and less reproducible than other antibody tests, and it should not be used as a test for evidence of a preceding GAS infection. | B | N/A |
| 177 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Studies suggesting that β-lactamase–producing upper respiratory tract flora may interfere with penicillin in the treatment of GAS pharyngitis have not been confirmed. Antibiotic therapy directed against these organisms remains controversial and is not indicated in patients with acute pharyngitis. | B | N/A |
| 178 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Sulfonamides and trimethoprim-sulfamethoxazole do not eradicate GAS in patients with pharyngitis and should not be used to treat active infections. | B | N/A |
| 179 | Rheumatic fever | 2009 | Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis | Until carefully designed and well-controlled studies have established a causal relationship between Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) and GAS infections, the committee does not recommend routine laboratory testing for GAS to diagnose, long-term antistreptococcal prophylaxis to prevent, or immunoregulatory therapy (eg, intravenous immunoglobulin, plasma exchange) to treat exacerbations of this disorder. | B | N/A |
| 180 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | AVR is not indicated in asymptomatic patients with AR who have normal LV size and function. | B | N/A |
| 181 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | AVR is not useful for prevention of sudden death in asymptomatic adults with AS who have none of the findings listed under the Class IIa/IIb indications. | B | N/A |
| 182 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Diagnostic cardiac catheterization is not indicated for uncomplicated PDA with adequate noninvasive imaging. | B | N/A |
| 183 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Endocardial pacing is not recommended in patients with CHD-PAH with persistent intravascular shunting, and alternative access for pacing leads should be sought (the risks should be individualized). | B | N/A |
| 184 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | In asymptomatic adolescents and young adults, aortic balloon valvotomy should not be performed with a peak-to-peak gradient less than 40 mm Hg without symptoms or ECG changes. | B | N/A |
| 185 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | In older adults, aortic balloon valvotomy is not recommended as an alternative to AVR, although certain younger patients may be an exception and should be referred to a center with experience in aortic balloon valvuloplasties. | B | N/A |
| 186 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | In younger patients with uncomplicated ASD for whom noninvasive imaging results are adequate, diagnostic cardiac catheterization is not indicated. | B | N/A |
| 187 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Maximal exercise testing is not recommended in ASD with severe PAH. | B | N/A |
| 188 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Maximal exercise testing is not recommended in PDA with significant PAH. | B | N/A |
| 189 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Patients with severe irreversible PAH and no evidence of a left-to-right shunt should not undergo ASD closure. | B | N/A |
| 190 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Pregnancy in women with CHD-PAH, especially those with Eisenmenger physiology, is not recommended and should be absolutely avoided in view of the high risk of maternal mortality. | B | N/A |
| 191 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Vasodilator therapy is not indicated for long-term therapy in AR for asymptomatic patients with LV systolic dysfunction who is otherwise a candidate for aortic valve replacement (AVR). | B | N/A |
| 192 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Vasodilator therapy is not indicated for long-term therapy in AR for asymptomatic patients with only mild to moderate AR and normal LV function. | B | N/A |
| 193 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | VSD closure is not recommended in patients with severe irreversible PAH. | B | N/A |
| 194 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | CRT is not indicated for asymptomatic patients with reduced LVEF in the absence of other indications for pacing. | B | N/A |
| 195 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for patients with ventricular tachyarrhythmias due to a completely reversible disorder in the absence of structural heart disease (e.g., electrolyte imbalance, drugs, or trauma). | B | N/A |
| 196 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic first-degree AV block. | B | N/A |
| 197 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for AV block that is expected to resolve and is unlikely to recur (e.g., drug toxicity, Lyme disease, or transient increases in vagal tone or during hypoxia in sleep apnea syndrome in the absence of symptoms). | B | N/A |
| 198 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for fascicular block with first-degree AV block without symptoms | B | N/A |
| 199 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for fascicular block without AV block or symptoms | B | N/A |
| 200 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for transient postoperative AV block with return of normal AV conduction in the otherwise asymptomatic patient. | B | N/A |
| 201 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for the prevention of AF in patients without any other indication for pacemaker implantation. | B | N/A |
| 202 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent ventricular pacing is not indicated for new bundle-branch block or fascicular block in the absence of AV block. | B | N/A |
| 203 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent ventricular pacing is not indicated for persistent asymptomatic first-degree AV block in the presence of bundle-branch or fascicular block. | B | N/A |
| 204 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent ventricular pacing is not indicated for transient AV block in the absence of intraventricular conduction defects. | B | N/A |
| 205 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent ventricular pacing is not indicated for transient AV block in the presence of isolated left anterior fascicular block. | B | N/A |
| 206 | Infective endocarditis (Update) | 2008 | ACC/AHA Guideline Update on Valvular Heart Disease Focused Update on Infective Endocarditis | Prophylaxis against infective endocarditis is not recommended for nondental procedures (such as transesophageal echocardiogram, esophagogastroduodenoscopy, or colonoscopy) in the absence of active infection. | B | N/A |
| 207 | Prevention of infective endocarditis | 2008 | AHA Guideline for the Prevention of Infective Endocarditis | The administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo GU or GI tract procedures, including diagnostic esophagogastroduodenoscopy or colonoscopy. | B | N/A |
| 208 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | Routine blood biomarker testing for the sole purpose of risk stratification in patients with heart failure is not warranted. | B | No benefit |
| 209 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | Routine blood BNP or NT-proBNP testing is not warranted for making specific therapeutic decisions for patients with acute or chronic heart failure because of the still emerging but incomplete data as well as intra- and inter-individual variations. | B | No benefit |
| 210 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | Routine blood natriuretic peptide (BNP or NT-proBNP) testing is not recommended for screening large asymptomatic patient populations for left ventricular dysfunction. | B | No benefit |
| 211 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Retransplantation is not efficacious when performed during the first 6 months after primary transplantation. | B | N/A |
| 212 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Retransplantation should not be performed during an episode of ongoing acute allograft rejection, even in the presence of graft vasculopathy. | B | N/A |
| 213 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | The limited supply of pediatric donors, especially infant donors, makes heart transplantation not a feasible standard therapy for any specific congenital heart lesion. | B | N/A |
| 214 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | Individuals found to be at low risk (<10% 10-year risk) or at high risk (>20% 10-year risk) do not benefit from coronary calcium assessment | B | N/A |
| 215 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | Serial imaging for assessment of progression of coronary calcification is not indicated at this time | B | N/A |
| 216 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Prophylactic antiarrhythmic drug therapy is not indicated to reduce mortality in patients with asymptomatic nonsustained ventricular arrhythmias. | B | No benefit |
| 217 | Diagnosis and treatment of infective endocarditis | 2005 | Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications | Until further definitive data are available, the routine use of aspirin for established endocarditis is not recommended. | B | N/A |
| 218 | Diagnosis and treatment of infective endocarditis | 2005 | Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications | Administration of clindamycin to treat infective endocarditis is associated with an unacceptable rate of relapse, and clindamycin use is not routinely recommended. | B | N/A |
| 219 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Axillofemoral-femoral bypass should not be used for the surgical treatment of patients with intermittent claudication except in very limited settings. | B | N/A |
| 220 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Plasma renin activity is not recommended as a useful screening test to establish the diagnosis of RAS. | B | N/A |
| 221 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Surgical revascularization is not indicated for patients with asymptomatic intestinal arterial obstructions, except in patients undergoing aortic/renal artery surgery for other indications. | B | N/A |
| 222 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Oral iloprost is not an effective therapy to reduce the risk of amputation or death in patients with CLI. | B | N/A |
| 223 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Parenteral administration of pentoxifylline is not useful for the treatment of CLI. | B | N/A |
| 224 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Patients with acute limb ischemia and a nonviable extremity should not undergo an evaluation to define vascular anatomy or efforts to attempt revascularization. | B | N/A |
| 225 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Selective renal vein renin measurements are not recommended as a useful screening test to establish the diagnosis of RAS. | B | N/A |
| 226 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Surgical intervention is not indicated to prevent progression to limb-threatening ischemia in patients with intermittent claudication. | B | N/A |
| 227 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | The captopril test (measurement of plasma renin activity after captopril administration) is not recommended as a useful screening test to establish the diagnosis of RAS. | B | N/A |
| 228 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Atenolol is not indicated as prophylactic therapy for patients with SVT during pregnancy. | B | N/A |
| 229 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Verapamil is not indicated among patients with wide QRS-complex tachycardia of unknown origin. | B | N/A |