Class III C 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 C is defined as evidence obtained from either a very limited number of populations, consensus opinion of experts, case studies, or standard of care. The total number of class III-LOE C recommendations in guidelines published by American cardiology societies is 277.
Class III C Recommendations: Organized by Guideline Keywords
The table shown below is a list of class III C 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 | Prophylactic use of anticonvulsants is not recommended. | C | N/A |
| 2 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Routine placement of indwelling bladder catheters is not recommended because of the associated risk of catheter-associated UTIs. | C | N/A |
| 3 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The administration of aspirin (or other antiplatelet agents) as an adjunctive therapy within 24 hours of intravenous fibrinolysis is not recommended. | C | N/A |
| 4 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The use of intravenous rtPA in patients taking direct thrombin inhibitors or direct factor Xa inhibitors may be harmful and is not recommended unless sensitive laboratory tests such as aPTT, INR, platelet count, and ECT, TT, or appropriate direct factor Xa activity assays are normal, or the patient has not received a dose of these agents for >2 days (assuming normal renal metabolizing function). Similar consideration should be given to patients being considered for intra-arterial rtPA. | C | Harm |
| 5 | Ankle-brachial index | 2012 | Measurement and Interpretation of the Ankle-Brachial Index | The use of the cuff over a distal bypass should be avoided (risk of bypass thrombosis). | C | Harm |
| 6 | Ankle-brachial index | 2012 | Measurement and Interpretation of the Ankle-Brachial Index | During follow-up, the ABI should not be used alone to follow revascularized patients. | C | No benefit |
| 7 | Aspirin for primary prevention in people with diabetes | 2010 | ADA/AHA/ACCF Aspirin for Primary Prevention of Cardiovascular Events in People With Diabetes | Aspirin should not be recommended for CVD prevention for adults with diabetes at low CVD risk (men under age 50 years and women under 60 years with no major additional CVD risk factors; 10-year CVD risk under 5%) as the potential adverse effects from bleeding offset the potential benefits. | C | Harm |
| 8 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Antiarrhythmic drugs for rhythm control should not be continued when AF becomes permanent. | C | Harm |
| 9 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Antiarrhythmic drugs in for rhythm control should not be continued when AF becomes permanent. | C | Harm |
| 10 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | AV nodal ablation with permanent ventricular pacing should not be performed to improve rate control without prior attempts to achieve rate control with medications. | C | Harm |
| 11 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Nondihydropyridine calcium channel antagonists should not be used in patients with decompensated HF as these may lead to further hemodynamic compromise. | C | Harm |
| 12 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | The direct thrombin inhibitor dabigatran and the factor Xa inhibitor rivaroxaban are not recommended in patients with AF and end-stage CKD or on dialysis because of the lack of evidence from clinical trials regarding the balance of risks and benefits. | C | No benefit |
| 13 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | AF catheter ablation should not be performed in patients who cannot be treated with anticoagulant therapy during and after the procedure. | C | Harm |
| 14 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | AF catheter ablation to restore sinus rhythm should not be performed with the sole intent of obviating the need for anticoagulation. | C | Harm |
| 15 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | AV node ablation should not be performed without a pharmacological trial to achieve ventricular rate control. | C | Harm |
| 16 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | For rate control, intravenous nondihydropyridine calcium channel antagonists, intravenous beta blockers, and dronedarone should not be administered to patients with decompensated HF. | C | Harm |
| 17 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | In diagnosing patients with heart failure, blood BNP or NT-proBNP testing should not be used to replace conventional clinical evaluation or assessment of the degree of left ventricular structural or functional abnormalities (eg, echocardiography, invasive hemodynamic assessment). | C | No benefit |
| 18 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | In diagnosing patients with heart failure, routine blood BNP or NT-proBNP testing for patients with an obvious clinical diagnosis of heart failure is not recommended. | C | No benefit |
| 19 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | An arterial graft should not be used to bypass the right coronary artery with less than a critical stenosis (<90%). | C | Harm |
| 20 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | CABG or PCI to improve symptoms should not be performed in patients who do not meet anatomic (>50% left main or >70% non–left main stenosis) or physiological (eg, abnormal fractional flow reserve) criteria for revascularization. | C | Harm |
| 21 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | CABG should not be performed in patients with end-stage renal disease whose life expectancy is limited by noncardiac issues. | C | Harm |
| 22 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | CABG should not be performed in patients with ventricular tachycardia with scar and no evidence of ischemia. | C | Harm |
| 23 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Emergency CABG should not be performed after failed PCI if revascularization is impossible because of target anatomy or a no-reflow state. | C | Harm |
| 24 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Emergency CABG should not be performed after failed PCI in the absence of ischemia or threatened occlusion. | C | Harm |
| 25 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Emergency CABG should not be performed in patients with noreflow (successful epicardial reperfusion with unsuccessful microvascular reperfusion). | C | Harm |
| 26 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Emergency CABG should not be performed in patients with persistent angina and a small area of viable myocardium who are stable hemodynamically. | C | Harm |
| 27 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Routine use of early extubation strategies in facilities with limited backup for airway emergencies or advanced respiratory support is potentially harmful. | C | Harm |
| 28 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Aortic valve balloon dilation is not indicated in children with isolated valvar AS who also have a degree of aortic regurgitation that warrants surgical aortic valve replacement or repair. | C | N/A |
| 29 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Aortic valvuloplasty is not indicated in children with isolated valvar AS who have a resting peak systolic valve gradient (by catheter) of <40 mm Hg† and who have no symptoms or ST-T-wave changes on electrocardiography. | C | N/A |
| 30 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Ductal stenting should not be performed in an infant with cyanotic CHD who has obvious proximal pulmonary artery stenosis in the vicinity of the ductal insertion. | C | N/A |
| 31 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Pulmonary venous angioplasty and stenting should not be considered in the management of pulmonary vein stenosis associated with other CHD that requires surgical intervention. | C | N/A |
| 32 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter ASD closure is contraindicated in the management of patients with a secundum ASD and advanced pulmonary vascular obstructive disease. | C | N/A |
| 33 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter ASD closure should not be performed with currently available devices in patients with ASDs other than those of the secundum variety. This would include defects of septum primum, sinus venosus defects, and unroofed coronary sinus defects. | C | N/A |
| 34 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter coil or device occlusion of a BTS (or Potts or Waterston shunt) is not recommended before the cardiac defect has been corrected if the patient develops unsatisfactory hypoxemia with balloon occlusion of the shunt. | C | N/A |
| 35 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter device occlusion is not indicated for patients with clinically insignificant coronary arteriovenous fistulae (eg, normal-sized cardiac chambers). | C | N/A |
| 36 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter device occlusion of a PVL is contraindicated when it is determined that there is inadequate space in which to seat the device without impairing valvar function. | C | N/A |
| 37 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter device occlusion of PVLs is not recommended for a small (hemodynamically insignificant) PVL or when hemolysis is mild or nonexistent. | C | N/A |
| 38 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter occlusion is not recommended for patients with pulmonary atresia with aortopulmonary collaterals that can be unifocalized into native pulmonary arteries. | C | N/A |
| 39 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter occlusion is not recommended for the presence of aortopulmonary collaterals of any size in biventricle or single-ventricle patients who have significant cyanosis due to decreased pulmonary flow. | C | N/A |
| 40 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter PDA occlusion should not be attempted in a patient with a PDA with severe pulmonary hypertension associated with bidirectional or right-to-left shunting that is unresponsive to pulmonary vasodilator therapy. | C | N/A |
| 41 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Venovenous collaterals that drain below the diaphragm in a patient scheduled to undergo Fontan completion need not be embolized. | C | N/A |
| 42 | 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 14 days of balloon angioplasty in patients in whom aspirin will need to be discontinued perioperatively. | C | Harm |
| 43 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Initiation or continuation of aspirin is not beneficial in patients undergoing elective noncardiac noncarotid surgery who have not had previous coronary stenting (Level of Evidence B), unless the risk of ischemic events outweighs the risk of surgical bleeding. | C | No benefit |
| 44 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine preoperative coronary angiography is not recommended. | C | No benefit |
| 45 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | The routine use of intraoperative transesophageal echocardiogram during noncardiac surgery to screen for cardiac abnormalities or to monitor for myocardial ischemia is not recommended in patients without risk factors or procedural risks for significant hemodynamic, pulmonary, or neurological compromise. | C | No benefit |
| 46 | Cardiovascular toxicity in cancer therapy | 2013 | Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy | The routine use of signal-averaged electrocardiography is not recommended for the evaluation of patients presenting with heart failure. | C | N/A |
| 47 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Prophylaxis against infective endocarditis (IE) is not recommended for nondental procedures (such as esophagogastroduodenoscopy or colonoscopy) in the absence of active infection. | C | N/A |
| 48 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Balloon valvotomy is not recommended for asymptomatic patients with a peak instantaneous gradient by Doppler less than 50 mm Hg in the presence of normal cardiac output. | C | N/A |
| 49 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Balloon valvotomy is not recommended for symptomatic patients with a peak instantaneous gradient by Doppler less than 30 mm Hg. | C | N/A |
| 50 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Balloon valvotomy is not recommended for symptomatic patients with PS and severe pulmonary regurgitation. | C | N/A |
| 51 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Cardiac catheterization is unnecessary for diagnosis of valvular PS and should be used only when percutaneous catheter intervention is contemplated. | C | N/A |
| 52 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Endocarditis prophylaxis is not recommended for those with a repaired PDA without residual shunt. | C | N/A |
| 53 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Estrogen-containing contraceptives should be avoided. | C | N/A |
| 54 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Exercise stress testing should not be performed in symptomatic patients with AS or those with repolarization abnormality on ECG or systolic dysfunction on echocardiography. | C | N/A |
| 55 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Patients with small, asymptomatic CAVF should not undergo closure of CAVF. | C | N/A |
| 56 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | PDA closure is not indicated for patients with PAH and net right-to-left shunt. | C | N/A |
| 57 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Pregnancy should not be planned without consultation and evaluation at a comprehensive ACHD center with experience and expertise in maternal and prenatal management of complex CHD. | C | N/A |
| 58 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Repeated routine phlebotomies are not recommended because of the risk of iron depletion, decreased oxygen carrying capacity, and stroke. | C | N/A |
| 59 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Surgical intervention is not recommended to prevent AR for patients with SubAS if the patient has trivial LVOT obstruction or trivial to mild AR. | C | N/A |
| 60 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | The estrogen-containing oral contraceptive pill is not recommended in ACHD patients at risk of thromboembolism, such as those with cyanosis related to an intracardiac shunt, severe PAH, or Fontan repair. | C | N/A |
| 61 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | The use of single-barrier contraception alone in women with CHD-PAH is not recommended owing to the frequency of failure. | C | N/A |
| 62 | 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 either LV systolic function or mild to moderate LV diastolic dysfunction who is otherwise a candidate for AVR. | C | N/A |
| 63 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | ACE Inhibitors and ARBs in the Hospital IV administration of ACE inhibitors is contraindicated in the first 24 hours because of risk of hypotension. | C | N/A |
| 64 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | NSAIDs (except for aspirin), both nonselective as well as COX-2 selective agents, should not be administered during hospitalization for STEMI because of the increased risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture associated with their use. | C | N/A |
| 65 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Patients initially treated with enoxaparin should not be switched to UFH and vice versa because of increased risk of bleeding. | C | N/A |
| 66 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Statins should not be discontinued during the index hospitalization unless contraindicated. | C | N/A |
| 67 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | The use of inpatient-derived risk scoring systems are not recommended to identify patients who may be safely discharged from the ED. | C | N/A |
| 68 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | The use of nitrates in patients with hypotension (SBP <90 mm Hg or ≥30 mm Hg below baseline), extreme bradycardia (<50 bpm), or tachycardia in the absence of heart failure (>100 bpm) and in patients with right ventricular infarction is contraindicated. | C | N/A |
| 69 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Adenosine should not be given for unstable or for irregular or polymorphic wide-complex tachycardias, as it may cause degeneration of the arrhythmia to VF. | C | N/A |
| 70 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | AV nodal blocking drugs (e.g. CCB or BB) should not be used for pre-excited atrial fibrillation or flutter. | C | N/A |
| 71 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | The routine use of cricoid pressure in cardiac arrest is not recommended. | C | N/A |
| 72 | CPR - Adult stroke | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Stroke | Following stroke, unless the patient is hypotensive (systolic blood pressure <90 mm Hg), prehospital intervention for blood pressure is not recommended. | C | N/A |
| 73 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | During rescue breathing, attempts to remove water from the breathing passages by any means other than suction (eg, abdominal thrusts or the Heimlich maneuver) are unnecessary and potentially dangerous. The routine use of abdominal thrusts or the Heimlich maneuver for drowning victims is not recommended. | C | N/A |
| 74 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | The effect of bolus administration of potassium for cardiac arrest suspected to be secondary to hypokalemia is unknown and ill advised. | C | N/A |
| 75 | CPR - CPR techniques and devices | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - CPR Techniques and Devices | Precordial thump should not be used for unwitnessed out-of-hospital cardiac arrest. | C | N/A |
| 76 | CPR - CPR techniques and devices | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - CPR Techniques and Devices | Rescuers should avoid using the automatic mode of the oxygen-powered, flow-limited resuscitator during CPR because it may generate high positive end-expiratory pressure (PEEP) that may impede venous return during chest compressions and compromise forward blood flow. | C | N/A |
| 77 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Among children with cocain toxicity do not give β-adrenergic blockers. | C | N/A |
| 78 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Among children with TCA or other sodium channel blocker toxicity, do not administer Class IA (quinidine, procainamide), Class IC (flecainide, propafenone), or Class III (amiodarone and sotalol) antiarrhythmics, which may exacerbate cardiac toxicity. | C | N/A |
| 79 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | An IV/IO dose of Verapamil, 0.1 to 0.3 mg/kg is effective in terminating SVT in older children, but it should not be used in infants without expert consultation because it may cause potential myocardial depression, hypotension, and cardiac arrest. | C | N/A |
| 80 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Avoid delivering excessive ventilation during cardiac arrest. | C | N/A |
| 81 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | In cases of trauma, do not routinely hyperventilate even in case of head injury (Class III, LOE C).338,339 Intentional brief hyperventilation may be used as a temporizing rescue therapy if there are signs of impending brain herniation (eg, sudden rise in measured intracranial pressure, dilation of one or both pupils with decreased response to light, bradycardia, and hypertension). | C | N/A |
| 82 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | There is insufficient evidence to recommend routine cricoid pressure application to prevent aspiration during endotracheal intubation in children. Do not continue cricoid pressure if it interferes with ventilation or the speed or ease of intubation. | C | N/A |
| 83 | CPR - Pediatric BLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Basic Life Support | During bag-mask ventilation, avoid excessive ventilation. | C | N/A |
| 84 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | Active rewarming should be avoided in comatose patients who spontaneously develop a mild degree of hypothermia (>32°C [89.6°F]) after resuscitation from cardiac arrest during the first 48 hours after ROSC. | C | N/A |
| 85 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | Routine hyperventilation with hypocapnia should be avoided after ROSC because it may worsen global brain ischemia by excessive cerebral vasoconstriction | C | N/A |
| 86 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | The absence of vestibulo-ocular reflexes at ≥24 hours (FPR 0%, 95% CI 0% to 14%) or Glasgow Coma Scale (GCS) score <5 at ≥72 hours (FPR 0%, 95% CI 0% to 6%) are less reliable for predicting poor outcome or were studied only in limited numbers of patients. Other clinical signs, including myoclonus, are not recommended for predicting poor outcome | C | N/A |
| 87 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | CT coronary angiography is not recommended in asymptomatic persons for the assessment of occult CAD | C | N/A |
| 88 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | Imaging of patients to follow up stent placement cannot be recommended | C | N/A |
| 89 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | It is not recommended to use CACP measure in asymptomatic persons to establish the presence of obstructive disease for subsequent revascularization | C | N/A |
| 90 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | The incremental benefit of hybrid imaging strategies will need to be demonstrated before clinical implementation, as radiation exposure may be significant with dual nuclear/CT imaging. Therefore, hybrid nuclear/CT imaging is not recommended | C | N/A |
| 91 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | There are limited data on variability but none on the prognostic implications of CT angiography for NCP assessment or on the utility of these measures to track atherosclerosis or stenosis over time; therefore, their use for these purposes is not recommended | C | N/A |
| 92 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | CRT is not indicated for patients whose functional status and life expectancy are limited predominantly by chronic noncardiac conditions. | C | N/A |
| 93 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD implantation is not indicated in pediatric patients and patients with congenital heart disease. | C | N/A |
| 94 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for NYHA Class IV patients with drug-refractory congestive heart failure who are not candidates for cardiac transplantation or CRT-D. | C | N/A |
| 95 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for patients who do not have a reasonable expectation of survival with an acceptable functional status for at least 1 year, even if they meet ICD implantation criteria specified in the Class I, IIa, and IIb recommendations. | C | N/A |
| 96 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for patients with incessant VT or VF. | C | N/A |
| 97 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for syncope of undetermined cause in a patient without inducible ventricular tachyarrhythmias and without structural heart disease. | C | N/A |
| 98 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated in patients with significant psychiatric illnesses that may be aggravated by device implantation or that may preclude systematic follow-up. | C | N/A |
| 99 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated when VF or VT is amenable to surgical or catheter ablation (e.g., atrial arrhythmias associated with the Wolff-Parkinson-White syndrome, RV or LV outflow tract VT, idiopathic VT, or fascicular VT in the absence of structural heart disease). | C | N/A |
| 100 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic bifascicular block with or without first-degree AV block after surgery for congenital heart disease in the absence of prior transient complete AV block. | C | N/A |
| 101 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic sinus bradycardia with the longest relative risk interval less than 3 seconds and a minimum heart rate more than 40 bpm. | C | N/A |
| 102 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic type I second-degree AV block at the supra-His (AV node) level or that which is not known to be intra- or infra-Hisian. | C | N/A |
| 103 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic type I second-degree AV block. | C | N/A |
| 104 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for patients who are asymptomatic or whose symptoms are medically controlled. | C | N/A |
| 105 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for SND in asymptomatic patients. | C | N/A |
| 106 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for SND in patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia. | C | N/A |
| 107 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for SND with symptomatic bradycardia due to nonessential drug therapy. | C | N/A |
| 108 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for symptomatic patients without evidence of LV outflow tract obstruction. | C | N/A |
| 109 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for a hypersensitive cardioinhibitory response to carotid sinus stimulation without symptoms or with vague symptoms. | C | N/A |
| 110 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for frequent or complex ventricular ectopic activity without sustained VT in the absence of the long-QT syndrome. | C | N/A |
| 111 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for situational vasovagal syncope in which avoidance behavior is effective and preferred. | C | N/A |
| 112 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated in the presence of an accessory pathway that has the capacity for rapid anterograde conduction. | C | N/A |
| 113 | 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 indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to less than 1 year. | C | N/A |
| 114 | ECG screening test | 2014 | Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age) | Mandatory and universal mass screening with 12-lead ECGs in large general populations of young healthy people 12 to 25 years of age (including on a national basis in the United States) to identify genetic/congenital and other cardiovascular abnormalities is not recommended for athletes and nonathletes alike. | C | No benefit |
| 115 | Endomyocardial biopsy | 2008 | The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease | Endomyocardial biopsy should not be performed in the setting of unexplained atrial fibrillation. | C | N/A |
| 116 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Administration of dopamine to the kidney transplant recipient is not beneficial for renal allograft function, and administration may be harmful. | C | N/A |
| 117 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Revascularization is not recommended for patients with asymptomatic FMD of a carotid artery, regardless of the severity of stenosis. | C | No benefit |
| 118 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Asymptomatic patients with asymmetrical upper limb BP, periclavicular bruit, or flow reversal in a vertebral artery caused by subclavian artery stenosis should not undergo revascularization unless the internal mammary artery is required for myocardial revascularization. | C | No benefit |
| 119 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Carotid duplex ultrasonography is not recommended for patients without risk factors for atherosclerotic carotid disease and no disease on initial vascular testing. | C | No benefit |
| 120 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Carotid duplex ultrasonography is not recommended for routine evaluation of patients with neurological or psychiatric disorders unrelated to focal cerebral ischemia. | C | No benefit |
| 121 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Carotid duplex ultrasonography is not recommended for routine screening of asymptomatic patients who have no risk factors for atherosclerosis. | C | No benefit |
| 122 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Except in extraordinary circumstances, carotid revascularization by either CEA or CAS is not recommended for patients with severe disability caused by cerebral infarction that precludes preservation of useful function. | C | No benefit |
| 123 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Reoperative CEA or CAS should not be performed in asymptomatic patients with less than 70% carotid stenosis that has remained stable. | C | Harm |
| 124 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for maternal infection other than rubella with seroconversion only. | C | N/A |
| 125 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | Do not administer anything by mouth for any poison ingestion unless advised to do so by a poison control center or emergency medical personnel because it may be harmful | C | N/A |
| 126 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | During electric injuries, do not place yourself in danger by touching an electrocuted victim while the power is on. Turn off the power at its source; at home the switch is usually near the fuse box. | C | N/A |
| 127 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | During injury emergencies, elevation and use of pressure points are not recommended to control bleeding. These unproven procedures may compromise the proven intervention of direct pressure, so they could be harmful. | C | N/A |
| 128 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | First aid providers should not use immobilization devices because their benefit in first aid has not been proven and they may be harmful. Immobilization devices may be needed in special circumstances when immediate extrication (eg, rescue of drowning victim) is required, but first aid providers should not use these devices unless they have been properly trained in their use. | C | N/A |
| 129 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | Following trauma, assume that any injury to an extremity includes a bone fracture. Cover open wounds with a dressing. Do not move or try to straighten an injured extremity. There is no evidence that straightening an angulated suspected long bone fracture shortens healing time or reduces pain prior to permanent fixation. | C | N/A |
| 130 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | In cases of frostbite, chemical warmers should not be placed directly on frostbitten tissue because they can reach temperatures that can cause burns | C | N/A |
| 131 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | In cases of frostbite, transport the victim to an advanced medical facility as rapidly as possible. Do not try to rewarm the frostbite if there is any chance that it might refreeze or if you are close to a medical facility. | C | N/A |
| 132 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | In jellyfish stings, ressure immobilization bandages are not recommended because animal studies show that pressure with an immobilization bandage causes further release of venom, even from already fired nematocysts. | C | N/A |
| 133 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | In snakebites, do not apply suction as first aid. Suction does remove some venom, but the amount is very small. Suction has no clinical benefit and it may aggravate the injury. | C | N/A |
| 134 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | CRT is not indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to less than 1 year. | C | No benefit |
| 135 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Endomyocardial biopsy should not be performed in the routine evaluation of patients with HF. | C | Harm |
| 136 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Hormonal therapies other than to correct deficiencies are not recommended for patients with current or prior symptoms of HFrEF. | C | No benefit |
| 137 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Long-term use of infused positive inotropic drugs is potentially harmful for patients with HFrEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment. | C | Harm |
| 138 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of HF after MI. | C | Harm |
| 139 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with HFrEF. | C | Harm |
| 140 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Routine use of nutritional supplements is not recommended for patients with HFpEF. | C | No benefit |
| 141 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Heart transplantation for pediatric heart disease is not efficacious when heart disease is associated with severe, irreversible disease in other organ systems or when it is part of a severe, irreversible, multisystemic disease process. Multiorgan transplantation may be considered. | C | N/A |
| 142 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Heart transplantation is generally not indicated in adults with previously repaired or palliated congenital heart disease with a peak maximal oxygen consumption of >15 mL · kg−1 · min−1 or >50% predicted for age and sex without other indications. | C | N/A |
| 143 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Heart transplantation is not feasible in the presence of severe hypoplasia of the central branch pulmonary arteries or pulmonary veins. | C | N/A |
| 144 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Heart transplantation should not be performed in adults with previously repaired or palliated congenital heart disease in whom comorbidities exist that would otherwise preclude heart transplantation in adults. | C | N/A |
| 145 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Orthotopic heart transplantation for pediatric heart disease is not efficacious when heart disease is associated with severe, irreversible, fixed elevation of pulmonary vascular resistance. | C | N/A |
| 146 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | For women with advanced heart failure symptoms and HCM, pregnancy is associated with excess morbidity/mortality. | C | Harm |
| 147 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Heart transplantation should not be performed in mildly symptomatic patients of any age with HCM. | C | Harm |
| 148 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Invasive electrophysiologic testing as routine SCD risk stratification for patients with HCM should not be performed. | C | Harm |
| 149 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverter-defibrillator for high-risk status. | C | Harm |
| 150 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Alcohol septal ablation should not be done in patients with HCM who are less than 21 years of age and is discouraged in adults less than 40 years of age if myectomy is a viable option. | C | Harm |
| 151 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Alcohol septal ablation should not be done in patients with HCM with concomitant disease that independently warrants surgical correction (eg, coronary artery bypass grafting for CAD, mitral valve repair for ruptured chordae) in whom surgical myectomy can be performed as part of the operation. | C | Harm |
| 152 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | ICD placement as a routine strategy in patients with HCM without an indication of increased risk is potentially harmful. | C | Harm |
| 153 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | ICD placement as a strategy to permit patients with HCM to participate in competitive athletics is potentially harmful. | C | Harm |
| 154 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | ICD placement in patients who have an identified HCM genotype in the absence of clinical manifestations of HCM is potentially harmful. | C | Harm |
| 155 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Mitral valve replacement for relief of LVOT obstruction should not be performed in patients with HCM in whom septal reduction therapy is an option. | C | Harm |
| 156 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Nifedipine or other dihydropyridine calcium channel-blocking drugs are potentially harmful for treatment of symptoms (angina or dyspnea) in patients with HCM who have resting or provocable LVOT obstruction. | C | Harm |
| 157 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Permanent pacemaker implantation for the purpose of reducing gradient should not be performed in patients with HCM who are asymptomatic or whose symptoms are medically controlled. | C | No benefit |
| 158 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Septal reduction therapy should not be done for adult patients with HCM who are asymptomatic with normal exercise tolerance or whose symptoms are controlled or minimized on optimal medical therapy. | C | Harm |
| 159 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Septal reduction therapy should not be done unless performed as part of a program dedicated to the longitudinal and multidisciplinary care of patients with HCM. | C | Harm |
| 160 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Verapamil is potentially harmful in patients with obstructive HCM in the setting of systemic hypotension or severe dyspnea at rest. | C | Harm |
| 161 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Assessment for the presence of blunted flow reserve (microvascular ischemia) using quantitative myocardial blood flow measurements by PET is not indicated for the assessment of prognosis in patients with HCM. | C | No benefit |
| 162 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | In patients with HCM with resting or provocable outflow tract obstruction, regardless of symptom status, pure vasodilators and high-dose diuretics are potentially harmful. | C | Harm |
| 163 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Routine SPECT MPI or stress echocardiography is not indicated for detection of “silent” CAD-related ischemia in patients with HCM who are asymptomatic. | C | No benefit |
| 164 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Routine TEE and/or contrast echocardiography is not recommended when TTE images are diagnostic of HCM and/or there is no suspicion of fixed obstruction or intrinsic mitral valve pathology. | C | No benefit |
| 165 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Septal reduction therapy should not be performed for asymptomatic adult and pediatric patients with HCM with normal effort tolerance regardless of the severity of obstruction. | C | Harm |
| 166 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | TTE studies should not be performed more frequently than every 12 months in patients with HCM when it is unlikely that any changes have occurred that would have an impact on clinical decision making. | C | No benefit |
| 167 | Mechanical circulatory support | 2012 | Recommendations for the Use of Mechanical Circulatory Support Device Strategies and Patient Selection | Long-term mechanical circulatory support is not recommended in patients with advanced kidney disease in whom renal function is unlikely to recover despite improved hemodynamics and who are therefore at high risk for progression to renal replacement therapy. | C | N/A |
| 168 | Noninvasive coronary artery imaging | 2008 | Noninvasive Coronary Artery Imaging Magnetic Resonance Angiography and Multidetector Computed Tomography Angiography | Neither coronary CTA nor MRA should be used to screen for coronary artery disease in patients who have no signs or symptoms suggestive of coronary artery disease. | C | N/A |
| 169 | Noninvasive coronary artery imaging | 2008 | Noninvasive Coronary Artery Imaging Magnetic Resonance Angiography and Multidetector Computed Tomography Angiography | patients with a high pretest likelihood of coronary stenoses are likely to require intervention and invasive catheter angiography for definitive evaluation; thus, CTA is not recommended for those individuals. | C | N/A |
| 170 | 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 in patients (both men and women) with acute chest pain and a low likelihood of ACS who are troponin-negative. | C | No benefit |
| 171 | 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 in patients with extensive comorbidities (eg, hepatic, renal, pulmonary failure; cancer), in whom the risks of revascularization and comorbid conditions are likely to outweigh the benefits of revascularization. | C | No benefit |
| 172 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Beta blockers should not be administered to patients with ACS with a recent history of cocaine or methamphetamine use who demonstrate signs of acute intoxication due to the risk of potentiating coronary spasm. | C | Harm |
| 173 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | A strategy of coronary angiography with intent to perform PCI is not recommended in patients with STEMI in whom the risks of revascularization are likely to outweigh the benefits or when the patient or designee does not want invasive care. | C | No benefit |
| 174 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | An early invasive strategy (ie, diagnostic angiography with intent to perform revascularization) is not recommended in patients with extensive comorbidities (eg, liver or pulmonary failure, cancer) in whom the risks of revascularization and comorbid conditions are likely to outweigh the benefits of revascularization, there is a low likelihood of ACS despite acute chest pain, or consent to revascularization will not be granted regardless of the findings. | C | No benefit |
| 175 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | CABG or PCI to improve symptoms should not be performed in patients who do not meet anatomic (≥50% left main or ≥70% non–left main stenosis) or physiological (eg, abnormal fractional flow reserve) criteria for revascularization. | C | Harm |
| 176 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Fondaparinux should not be used as the sole anticoagulant to support PCI. An additional anticoagulant with anti-IIa activity should be administered because of the risk of catheter thrombosis. | C | Harm |
| 177 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | In patients with a prior history of allergic reactions to shellfish or seafood, anaphylactoid prophylaxis for contrast reaction is not beneficial. | C | No benefit |
| 178 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | It is not recommended that elective/urgent PCI be performed by low-volume operators (<75 procedures per year) at low-volume centers (200 to 400 procedures per year) with or without on-site cardiac surgery. An institution with a volume of fewer than 200 procedures per year, unless in a region that is underserved because of geography, should carefully consider whether it should continue to offer this service. | C | No benefit |
| 179 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | IVUS for routine lesion assessment is not recommended when revascularization with PCI or CABG is not being contemplated. | C | No benefit |
| 180 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI is not recommended for chronic saphenous vein graft occlusions. | C | Harm |
| 181 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Primary or elective PCI should not be performed in hospitals without on-site cardiac surgery capabilities without a proven plan for rapid transport to a cardiac surgery operating room in a nearby hospital or without appropriate hemodynamic support capability for transfer. | C | Harm |
| 182 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Routine periodic stress testing of asymptomatic patients after PCI without specific clinical indications should not be performed. | C | No benefit |
| 183 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Routine use of a proton pump inhibitor is not recommended for patients at low risk of gastrointestinal bleeding, who have much less potential to benefit from prophylactic therapy. | C | No benefit |
| 184 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | The routine clinical use of genetic testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended. | C | No benefit |
| 185 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | The routine clinical use of platelet function testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended. | C | No benefit |
| 186 | PCI without on-site surgical back-up | 2014 | SCAI/ACC/AHA Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup | It is not recommended to perform a primary or elective PCI in hospitals without on-site cardiac surgery without a proven plan for rapid transport to a cardiac surgery operating room in a nearby hospital and without appropriate hemodynamic support capability for transfers. | C | N/A |
| 187 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Oral anticoagulation therapy with warfarin is not indicated to reduce the risk of adverse cardiovascular ischemic events in individuals with atherosclerotic lower extremity PAD. | C | N/A |
| 188 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Arterial imaging is not indicated for patients with a normal postexercise ABI. This does not apply if other atherosclerotic causes (e.g., entrapment syndromes or isolated internal iliac artery occlusive disease) are suspected. | C | N/A |
| 189 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Primary stent placement is not recommended in the femoral, popliteal, or tibial arteries. | C | N/A |
| 190 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Surgical and endovascular intervention is not indicated in patients with severe decrements in limb perfusion (e.g., ABI less than 0.4) in the absence of clinical symptoms of CLI. | C | N/A |
| 191 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Vitamin E is not recommended as a treatment for patients with intermittent claudication. | C | N/A |
| 192 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Captopril renal scintigraphy is not recommended as a screening test to establish the diagnosis of RAS. | C | N/A |
| 193 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Endovascular intervention is not indicated as prophylactic therapy in an asymptomatic patient with lower extremity PAD. | C | N/A |
| 194 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Endovascular intervention is not indicated if there is no significant pressure gradient across a stenosis despite flow augmentation with vasodilators. | C | N/A |
| 195 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Femoral-tibial artery bypasses with synthetic graft material should not be used for the treatment of claudication. | C | N/A |
| 196 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | In contrast to chronic intestinal ischemia, duplex sonography of the abdomen is not an appropriate diagnostic tool for suspected acute intestinal ischemia. | C | N/A |
| 197 | Prevention of infective endocarditis | 2008 | AHA Guideline for the Prevention of Infective Endocarditis | There is no evidence that coronary artery bypass graft surgery is associated with a long-term risk for infection. Therefore, antibiotic prophylaxis for dental procedures is not needed for individuals who have undergone this surgery. Antibiotic prophylaxis for dental procedures is not recommended for patients with coronary artery stents. | C | N/A |
| 198 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Dosing with vitamin K antagonists on the basis of pharmacogenetics is not recommended at this time. | C | N/A |
| 199 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Genetic screening of the general population for prevention of a first stroke is not recommended. | C | N/A |
| 200 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Noninvasive screening for unruptured intracranial aneurysms in patients with 1 relative with SAH or intracranial aneurysms is not recommended. | C | N/A |
| 201 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | OCs may be harmful in women with additional risk factors (eg, cigarette smoking, prior thromboembolic events). | C | N/A |
| 202 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Screening of patients at risk for myopathy in the setting of statin use is not recommended when considering initiation of statin therapy at this time. | C | N/A |
| 203 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Universal screening for intracranial aneurysms in carriers of mutations for Mendelian disorders associated with aneurysm is not recommended. | C | N/A |
| 204 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Coronary computed tomography angiography is not recommended for cardiovascular risk assessment in asymptomatic adults. | C | No benefit |
| 205 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Echocardiography is not recommended for cardiovascular risk assessment of CHD in asymptomatic adults without hypertension. | C | No benefit |
| 206 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Magnetic resonance imaging for detection of vascular plaque is not recommended for cardiovascular risk assessment in asymptomatic adults. | C | No benefit |
| 207 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Measures of arterial stiffness outside of research settings are not recommended for cardiovascular risk assessment in asymptomatic adults. | C | No benefit |
| 208 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Stress MPI is not indicated for cardiovascular risk assessment in low- or intermediate-risk asymptomatic adults. (Exercise or pharmacologic stress MPI is primarily used and studied for its role in advanced cardiac evaluation of symptoms suspected of representing CHD and/or estimation of prognosis in patients with known coronary artery disease. | C | No benefit |
| 209 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Measurement of lipid parameters, including lipoproteins, apolipoproteins, particle size, and density, beyond a standard fasting lipid profile is not recommended for cardiovascular risk assessment in asymptomatic adults. | C | No benefit |
| 210 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Stress echocardiography is not indicated for cardiovascular risk assessment in low- or intermediate-risk asymptomatic adults. (Exercise or pharmacologic stress echocardiography is primarily used for its role in advanced cardiac evaluation of symptoms suspected of representing CHD and/or estimation of prognosis in patients with known coronary artery disease or the assessment of patients with known or suspected valvular heart disease.) | C | No benefit |
| 211 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Antithrombotic alternatives to warfarin (dabigatran, apixaban, rivaroxaban) should not be routinely administered early after CABG until additional safety data have accrued. | C | N/A |
| 212 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with rheumatic mitral valve disease who are prescribed VKA therapy after an ischemic stroke or TIA, antiplatelet therapy should not be routinely added. | C | N/A |
| 213 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Routine screening for hyperhomocysteinemia among patients with a recent ischemic stroke or TIA is not indicated. | C | N/A |
| 214 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Routine testing for antiphospholipid antibodies is not recommended for patients with ischemic stroke or TIA who have no other manifestations of the antiphospholipid antibody syndrome and who have an alternative explanation for their ischemic event, such as atherosclerosis, carotid stenosis, or AF. | C | N/A |
| 215 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Surgical endarterectomy of aortic arch plaque for the purposes of secondary stroke prevention is not recommended. | C | N/A |
| 216 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Cardiovascular drugs that can improve symptoms and survival should not be withheld because of concerns about the potential impact on sexual function. | C | N/A |
| 217 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Patients with CVD who experience cardiovascular symptoms precipitated by sexual activity should defer sexual activity until their condition is stabilized and optimally managed. | C | N/A |
| 218 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Patients with unstable, decompensated, and/or severe symptomatic CVD should defer sexual activity until their condition is stabilized and optimally managed. | C | N/A |
| 219 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity is not advised for patients with decompensated or advanced (NYHA class III or IV) heart failure until their condition is stabilized and optimally managed. | C | N/A |
| 220 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity is not advised for patients with severe or significantly symptomatic valvular disease until their condition is stabilized and optimally managed. | C | N/A |
| 221 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity should be deferred for patients with atrial fibrillation and poorly controlled ventricular rate, uncontrolled or symptomatic supraventricular arrhythmias, and spontaneous or exercise-induced ventricular tachycardia until the condition is optimally managed. | C | N/A |
| 222 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity should be deferred for patients with HCM who are severely symptomatic until their condition is stabilized. | C | N/A |
| 223 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity should be deferred for patients with unstable or refractory angina until their condition is stabilized and optimally managed. | C | N/A |
| 224 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity should be deferred in patients with an ICD who have received multiple shocks until the causative arrhythmia is stabilized and optimally controlled. | C | N/A |
| 225 | 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 | A request to perform either more than 1 stress imaging study or a stress imaging study and a CCTA at the same time is not recommended for risk assessment in patients with SIHD. | C | No benefit |
| 226 | 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 | Acupuncture should not be used for the purpose of improving symptoms or reducing cardiovascular risk in patients with SIHD. | C | No benefit |
| 227 | 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 to improve symptoms should not be performed in patients who do not meet anatomic (≥50% diameter left main or ≥70% non–left main stenosis diameter) or physiological (eg, abnormal FFR) criteria for revascularization. | C | Harm |
| 228 | 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 | Chelation therapy is not recommended with the intent of improving symptoms or reducing cardiovascular risk in patients with SIHD. | C | No benefit |
| 229 | 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 assess risk in asymptomatic patients with no evidence of ischemia on noninvasive testing. | C | No benefit |
| 230 | 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 assess risk in patients who are at low risk according to clinical criteria and who have not undergone noninvasive risk testing. | C | No benefit |
| 231 | 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 | Echocardiography, radionuclide imaging, CMR, and cardiac CT are not recommended for routine assessment of LV function in patients with a normal ECG, no history of MI, no symptoms or signs suggestive of heart failure, and no complex ventricular arrhythmias. | C | No benefit |
| 232 | 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 | Exercise stress with nuclear MPI is not recommended as an initial test in low-risk patients who have an interpretable ECG and at least moderate physical functioning or no disabling comorbidity. | C | No benefit |
| 233 | 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 | Measurement of LV function with a technology such as echocardiography or radionuclide imaging is not recommended for routine periodic reassessment of patients who have not had a change in clinical status or who are at low risk of adverse cardiovascular events. | C | No benefit |
| 234 | 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 | Nuclear MPI, echocardiography, or CMR, with either exercise or pharmacological stress or CCTA, is not recommended for follow-up assessment in patients with SIHD, if performed more frequently than at a) 5-year intervals after CABG or b) 2-year intervals after PCI. | C | No benefit |
| 235 | 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 | Pharmacological stress imaging (nuclear MPI, echocardiography, or CMR) or CCTA is not recommended for risk assessment in patients with SIHD who are able to exercise to an adequate workload and have an interpretable ECG. | C | No benefit |
| 236 | 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 | Pharmacological stress imaging with nuclear MPI, echocardiography, or CMR is not recommended in patients with known SIHD who have new or worsening symptoms not consistent with UA and who are capable of at least moderate physical functioning or have no disabling comorbidity. | C | No benefit |
| 237 | 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 | Standard exercise ECG testing is not recommended for patients who have an uninterpretable ECG or are incapable of at least moderate physical functioning or have disabling comorbidity. | C | No benefit |
| 238 | 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 | Standard exercise ECG testing should not be performed in patients with known SIHD who have new or worsening symptoms not consistent with UA and who are either incapable of at least moderate physical functioning/have disabling comorbidity or have an uninterpretable ECG. | C | No benefit |
| 239 | 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 | Therapy with rosiglitazone should not be initiated in patients with SIHD. | C | Harm |
| 240 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | Treatment with garlic, coenzyme Q10, selenium, or chromium is not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD. | C | No benefit |
| 241 | 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 | Pharmacological stress with nuclear MPI, echocardiography, or CMR is not recommended for patients who have an interpretable ECG and at least moderate physical functioning or no disabling comorbidity. | C | No benefit |
| 242 | 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 | Routine reassessment (<1 year) of LV function with technologies such as echocardiography radionuclide imaging, CMR, or cardiac computed tomography is not recommended in patients with no change in clinical status and for whom no change in therapy is contemplated. | C | No benefit |
| 243 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | Application of management guidelines for ACS should not be based solely on measurement of CRP. | C | N/A |
| 244 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | Application of management guidelines for ACS should not be based solely on measurement of natriuretic peptides. | C | N/A |
| 245 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | Biomarkers of necrosis should not be used for routine screening of patients with low clinical probability of ACS. | C | N/A |
| 246 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | For patients with diagnostic ECG abnormalities on presentation (e.g., new ST-segment elevation), diagnosis and treatment should not be delayed while awaiting biomarker results. | C | N/A |
| 247 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | Total CK, CK-MB activity, aspartate aminotransferase (AST, SGOT), β-hydroxybutyric dehydrogenase, and/or lactate dehydrogenase should not be used as biomarkers for the diagnosis of MI. | C | N/A |
| 248 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Amiodarone is not indicated as prophylactic therapy for patients with SVT during pregnancy. | C | N/A |
| 249 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Beta blockers are not indicated among patients with wide QRS-complex tachycardia of unknown origin. | C | N/A |
| 250 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Catheter ablation is not indicated as prophylactic therapy for patients with non-sustained and asymptomatic focal atrial tachycardia. | C | N/A |
| 251 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Closure of unrepaired asymptomatic ASD that is not associated with significant hemodynamic changes is not recommended to treat SVT in adults with congenital heart disease. | C | N/A |
| 252 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Digoxin is not indicated among patients with single or infrequent AVRT episode(s) with no pre-excitation. | C | N/A |
| 253 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Verapamil, diltiazem, or digoxin is not indicated among patients with AVRT that is poorly tolerated with no pre-excitation. | C | N/A |
| 254 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Verapamil, diltiazem, or digoxin is not indicated among patients with WPW syndrome, with pre-excitation and symptomatic arrhythmias that are well-tolerated. | C | N/A |
| 255 | 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 | A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening. | C | N/A |
| 256 | 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 | Regional anesthetic techniques are not recommended in patients at risk of neuraxial hematoma formation due to thienopyridine antiplatelet therapy, low-molecular-weight heparins, or clinically significant anticoagulation. | C | N/A |
| 257 | 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 | Routinely changing double-lumen endotracheal (endobronchial) tubes to single-lumen tubes at the end of surgical procedures complicated by significant upper airway edema or hemorrhage is not recommended. | C | N/A |
| 258 | 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 | Vasodilator therapy should not be initiated prior to rate control so as to avoid associated reflex tachycardia that may increase aortic wall stress, leading to propagation or expansion of a thoracic aortic dissection. | C | N/A |
| 259 | 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 | A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening. | C | N/A |
| 260 | 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 | Vasodilator therapy should not be initiated prior to rate control so as to avoid associated reflex tachycardia that may increase aortic wall stress, leading to propagation or expansion of a thoracic aortic dissection. | C | N/A |
| 261 | 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 | Regional anesthetic techniques are not recommended in patients at risk of neuraxial hematoma formation due to thienopyridine antiplatelet therapy, low-molecular-weight heparins, or clinically significant anticoagulation. | C | N/A |
| 262 | 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 | Routinely changing double-lumen endotracheal (endobronchial) tubes to single-lumen tubes at the end of surgical procedures complicated by significant upper airway edema or hemorrhage is not recommended. | C | N/A |
| 263 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Patients with known VHD should not receive antibiotics before blood cultures are obtained for unexplained fever. | C | Harm |
| 264 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Valve operation should not be performed in pregnant patients with valve stenosis in the absence of severe HF symptoms. | C | Harm |
| 265 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Valve operations should not be performed in pregnant patients with valve regurgitation in the absence of severe intractable HF symptoms. | C | Harm |
| 266 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Ablation is not indicated in young patients with asymptomatic NSVT and normal ventricular function. | C | N/A |
| 267 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Ablation of asymptomatic relatively infrequent PVCs is not indicated. | C | N/A |
| 268 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Calcium channel blockers such as verapamil and diltiazem should not be used in patients to terminate wide-QRS-complex tachycardia of unknown origin, especially in patients with a history of myocardial dysfunction. | C | N/A |
| 269 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Digoxin or verapamil should not be used for treatment of sustained tachycardia in infants when VT has not been excluded as a potential diagnosis. | C | N/A |
| 270 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Elderly patients with projected life expectancy less than 1 y due to major comorbidities should not receive ICD therapy. | C | N/A |
| 271 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | ICD implantation is not indicated during the acute phase of myocarditis. | C | N/A |
| 272 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Pharmacological treatment of isolated PVCs in pediatric patients is not recommended. | C | N/A |
| 273 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Prolonged, unbalanced, very low calorie, semistarvation diets are not recommended; they may be harmful and provoke life-threatening ventricular arrhythmias. | C | N/A |
| 274 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Prophylactic antiarrhythmic therapy generally is not indicated for primary prevention of SCD in patients with pulmonary arterial hypertension (PAH) or other pulmonary conditions. | C | N/A |
| 275 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Prophylactic antiarrhythmic therapy is not indicated for asymptomatic patients with congenital heart disease and isolated PVCs. | C | N/A |
| 276 | 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 as an adjuvant to anticoagulation and systemic fibrinolysis in the treatment of acute PE. | C | N/A |
| 277 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | Catheter embolectomy and surgical thrombectomy are not recommended for patients with low-risk PE or submassive acute PE with minor RV dysfunction, minor myocardial necrosis, and no clinical worsening. | C | N/A |
Class III C Recommendations: Organized by Year of Guideline Publication
The table shown below is a list of class III C recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by year of guideline publication. Alternatively, to view the same list organized by guideline name/keywords, click here.
| Number | Guideline Keywords | Year of Guideline Publication | Title of Guideline | Class III Recommendation | Level of Evidence | Effect |
| 1 | Secondary prevention after CABG | 2015 | Secondary Prevention After Coronary Artery Bypass Graft Surgery | Antithrombotic alternatives to warfarin (dabigatran, apixaban, rivaroxaban) should not be routinely administered early after CABG until additional safety data have accrued. | C | N/A |
| 2 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Antiarrhythmic drugs for rhythm control should not be continued when AF becomes permanent. | C | Harm |
| 3 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Antiarrhythmic drugs in for rhythm control should not be continued when AF becomes permanent. | C | Harm |
| 4 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | AV nodal ablation with permanent ventricular pacing should not be performed to improve rate control without prior attempts to achieve rate control with medications. | C | Harm |
| 5 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | Nondihydropyridine calcium channel antagonists should not be used in patients with decompensated HF as these may lead to further hemodynamic compromise. | C | Harm |
| 6 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | The direct thrombin inhibitor dabigatran and the factor Xa inhibitor rivaroxaban are not recommended in patients with AF and end-stage CKD or on dialysis because of the lack of evidence from clinical trials regarding the balance of risks and benefits. | C | No benefit |
| 7 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | AF catheter ablation should not be performed in patients who cannot be treated with anticoagulant therapy during and after the procedure. | C | Harm |
| 8 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | AF catheter ablation to restore sinus rhythm should not be performed with the sole intent of obviating the need for anticoagulation. | C | Harm |
| 9 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | AV node ablation should not be performed without a pharmacological trial to achieve ventricular rate control. | C | Harm |
| 10 | Atrial fibrillation | 2014 | AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation | For rate control, intravenous nondihydropyridine calcium channel antagonists, intravenous beta blockers, and dronedarone should not be administered to patients with decompensated HF. | C | Harm |
| 11 | 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 14 days of balloon angioplasty in patients in whom aspirin will need to be discontinued perioperatively. | C | Harm |
| 12 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Initiation or continuation of aspirin is not beneficial in patients undergoing elective noncardiac noncarotid surgery who have not had previous coronary stenting (Level of Evidence B), unless the risk of ischemic events outweighs the risk of surgical bleeding. | C | No benefit |
| 13 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | Routine preoperative coronary angiography is not recommended. | C | No benefit |
| 14 | Cardiac evaluation for noncardiac surgery | 2014 | ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery | The routine use of intraoperative transesophageal echocardiogram during noncardiac surgery to screen for cardiac abnormalities or to monitor for myocardial ischemia is not recommended in patients without risk factors or procedural risks for significant hemodynamic, pulmonary, or neurological compromise. | C | No benefit |
| 15 | ECG screening test | 2014 | Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age) | Mandatory and universal mass screening with 12-lead ECGs in large general populations of young healthy people 12 to 25 years of age (including on a national basis in the United States) to identify genetic/congenital and other cardiovascular abnormalities is not recommended for athletes and nonathletes alike. | C | No benefit |
| 16 | Fetal cardiac disease | 2014 | Diagnosis and Treatment of Fetal Cardiac Disease | Referral for fetal cardiac evaluation is not indicated for maternal infection other than rubella with seroconversion only. | C | N/A |
| 17 | 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 in patients (both men and women) with acute chest pain and a low likelihood of ACS who are troponin-negative. | C | No benefit |
| 18 | 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 in patients with extensive comorbidities (eg, hepatic, renal, pulmonary failure; cancer), in whom the risks of revascularization and comorbid conditions are likely to outweigh the benefits of revascularization. | C | No benefit |
| 19 | NSTE ACS (NSTEMI and unstable angina) | 2014 | AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes | Beta blockers should not be administered to patients with ACS with a recent history of cocaine or methamphetamine use who demonstrate signs of acute intoxication due to the risk of potentiating coronary spasm. | C | Harm |
| 20 | PCI without on-site surgical back-up | 2014 | SCAI/ACC/AHA Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup | It is not recommended to perform a primary or elective PCI in hospitals without on-site cardiac surgery without a proven plan for rapid transport to a cardiac surgery operating room in a nearby hospital and without appropriate hemodynamic support capability for transfers. | C | N/A |
| 21 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | For patients with rheumatic mitral valve disease who are prescribed VKA therapy after an ischemic stroke or TIA, antiplatelet therapy should not be routinely added. | C | N/A |
| 22 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Routine screening for hyperhomocysteinemia among patients with a recent ischemic stroke or TIA is not indicated. | C | N/A |
| 23 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Routine testing for antiphospholipid antibodies is not recommended for patients with ischemic stroke or TIA who have no other manifestations of the antiphospholipid antibody syndrome and who have an alternative explanation for their ischemic event, such as atherosclerosis, carotid stenosis, or AF. | C | N/A |
| 24 | Secondary prevention of stroke | 2014 | Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack | Surgical endarterectomy of aortic arch plaque for the purposes of secondary stroke prevention is not recommended. | C | N/A |
| 25 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Patients with known VHD should not receive antibiotics before blood cultures are obtained for unexplained fever. | C | Harm |
| 26 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Valve operation should not be performed in pregnant patients with valve stenosis in the absence of severe HF symptoms. | C | Harm |
| 27 | Valvular heart disease | 2014 | AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease | Valve operations should not be performed in pregnant patients with valve regurgitation in the absence of severe intractable HF symptoms. | C | Harm |
| 28 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Prophylactic use of anticonvulsants is not recommended. | C | N/A |
| 29 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Routine placement of indwelling bladder catheters is not recommended because of the associated risk of catheter-associated UTIs. | C | N/A |
| 30 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The administration of aspirin (or other antiplatelet agents) as an adjunctive therapy within 24 hours of intravenous fibrinolysis is not recommended. | C | N/A |
| 31 | Acute ischemic stroke | 2013 | Guidelines for the Early Management of Patients With Acute Ischemic Stroke | The use of intravenous rtPA in patients taking direct thrombin inhibitors or direct factor Xa inhibitors may be harmful and is not recommended unless sensitive laboratory tests such as aPTT, INR, platelet count, and ECT, TT, or appropriate direct factor Xa activity assays are normal, or the patient has not received a dose of these agents for >2 days (assuming normal renal metabolizing function). Similar consideration should be given to patients being considered for intra-arterial rtPA. | C | Harm |
| 32 | Cardiovascular toxicity in cancer therapy | 2013 | Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy | The routine use of signal-averaged electrocardiography is not recommended for the evaluation of patients presenting with heart failure. | C | N/A |
| 33 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | CRT is not indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to less than 1 year. | C | No benefit |
| 34 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Endomyocardial biopsy should not be performed in the routine evaluation of patients with HF. | C | Harm |
| 35 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Hormonal therapies other than to correct deficiencies are not recommended for patients with current or prior symptoms of HFrEF. | C | No benefit |
| 36 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Long-term use of infused positive inotropic drugs is potentially harmful for patients with HFrEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment. | C | Harm |
| 37 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of HF after MI. | C | Harm |
| 38 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with HFrEF. | C | Harm |
| 39 | Heart failure | 2013 | ACCF/AHA Guideline for the Management of Heart Failure | Routine use of nutritional supplements is not recommended for patients with HFpEF. | C | No benefit |
| 40 | Ankle-brachial index | 2012 | Measurement and Interpretation of the Ankle-Brachial Index | The use of the cuff over a distal bypass should be avoided (risk of bypass thrombosis). | C | Harm |
| 41 | Ankle-brachial index | 2012 | Measurement and Interpretation of the Ankle-Brachial Index | During follow-up, the ABI should not be used alone to follow revascularized patients. | C | No benefit |
| 42 | 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 indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to less than 1 year. | C | N/A |
| 43 | Evaluation for kidney and liver transplantation | 2012 | Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates | Administration of dopamine to the kidney transplant recipient is not beneficial for renal allograft function, and administration may be harmful. | C | N/A |
| 44 | Mechanical circulatory support | 2012 | Recommendations for the Use of Mechanical Circulatory Support Device Strategies and Patient Selection | Long-term mechanical circulatory support is not recommended in patients with advanced kidney disease in whom renal function is unlikely to recover despite improved hemodynamics and who are therefore at high risk for progression to renal replacement therapy. | C | N/A |
| 45 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Cardiovascular drugs that can improve symptoms and survival should not be withheld because of concerns about the potential impact on sexual function. | C | N/A |
| 46 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Patients with CVD who experience cardiovascular symptoms precipitated by sexual activity should defer sexual activity until their condition is stabilized and optimally managed. | C | N/A |
| 47 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Patients with unstable, decompensated, and/or severe symptomatic CVD should defer sexual activity until their condition is stabilized and optimally managed. | C | N/A |
| 48 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity is not advised for patients with decompensated or advanced (NYHA class III or IV) heart failure until their condition is stabilized and optimally managed. | C | N/A |
| 49 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity is not advised for patients with severe or significantly symptomatic valvular disease until their condition is stabilized and optimally managed. | C | N/A |
| 50 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity should be deferred for patients with atrial fibrillation and poorly controlled ventricular rate, uncontrolled or symptomatic supraventricular arrhythmias, and spontaneous or exercise-induced ventricular tachycardia until the condition is optimally managed. | C | N/A |
| 51 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity should be deferred for patients with HCM who are severely symptomatic until their condition is stabilized. | C | N/A |
| 52 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity should be deferred for patients with unstable or refractory angina until their condition is stabilized and optimally managed. | C | N/A |
| 53 | Sexual activity and cardiovascular disease | 2012 | Sexual Activity and Cardiovascular Disease | Sexual activity should be deferred in patients with an ICD who have received multiple shocks until the causative arrhythmia is stabilized and optimally controlled. | C | N/A |
| 54 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | A request to perform either more than 1 stress imaging study or a stress imaging study and a CCTA at the same time is not recommended for risk assessment in patients with SIHD. | C | No benefit |
| 55 | 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 | Acupuncture should not be used for the purpose of improving symptoms or reducing cardiovascular risk in patients with SIHD. | C | No benefit |
| 56 | 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 to improve symptoms should not be performed in patients who do not meet anatomic (≥50% diameter left main or ≥70% non–left main stenosis diameter) or physiological (eg, abnormal FFR) criteria for revascularization. | C | Harm |
| 57 | 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 | Chelation therapy is not recommended with the intent of improving symptoms or reducing cardiovascular risk in patients with SIHD. | C | No benefit |
| 58 | 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 assess risk in asymptomatic patients with no evidence of ischemia on noninvasive testing. | C | No benefit |
| 59 | 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 assess risk in patients who are at low risk according to clinical criteria and who have not undergone noninvasive risk testing. | C | No benefit |
| 60 | 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 | Echocardiography, radionuclide imaging, CMR, and cardiac CT are not recommended for routine assessment of LV function in patients with a normal ECG, no history of MI, no symptoms or signs suggestive of heart failure, and no complex ventricular arrhythmias. | C | No benefit |
| 61 | 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 | Exercise stress with nuclear MPI is not recommended as an initial test in low-risk patients who have an interpretable ECG and at least moderate physical functioning or no disabling comorbidity. | C | No benefit |
| 62 | 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 | Measurement of LV function with a technology such as echocardiography or radionuclide imaging is not recommended for routine periodic reassessment of patients who have not had a change in clinical status or who are at low risk of adverse cardiovascular events. | C | No benefit |
| 63 | 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 | Nuclear MPI, echocardiography, or CMR, with either exercise or pharmacological stress or CCTA, is not recommended for follow-up assessment in patients with SIHD, if performed more frequently than at a) 5-year intervals after CABG or b) 2-year intervals after PCI. | C | No benefit |
| 64 | 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 | Pharmacological stress imaging (nuclear MPI, echocardiography, or CMR) or CCTA is not recommended for risk assessment in patients with SIHD who are able to exercise to an adequate workload and have an interpretable ECG. | C | No benefit |
| 65 | 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 | Pharmacological stress imaging with nuclear MPI, echocardiography, or CMR is not recommended in patients with known SIHD who have new or worsening symptoms not consistent with UA and who are capable of at least moderate physical functioning or have no disabling comorbidity. | C | No benefit |
| 66 | 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 | Standard exercise ECG testing is not recommended for patients who have an uninterpretable ECG or are incapable of at least moderate physical functioning or have disabling comorbidity. | C | No benefit |
| 67 | 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 | Standard exercise ECG testing should not be performed in patients with known SIHD who have new or worsening symptoms not consistent with UA and who are either incapable of at least moderate physical functioning/have disabling comorbidity or have an uninterpretable ECG. | C | No benefit |
| 68 | 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 | Therapy with rosiglitazone should not be initiated in patients with SIHD. | C | Harm |
| 69 | Stable ischemic heart disease | 2012 | ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease | Treatment with garlic, coenzyme Q10, selenium, or chromium is not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD. | C | No benefit |
| 70 | 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 | Pharmacological stress with nuclear MPI, echocardiography, or CMR is not recommended for patients who have an interpretable ECG and at least moderate physical functioning or no disabling comorbidity. | C | No benefit |
| 71 | 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 | Routine reassessment (<1 year) of LV function with technologies such as echocardiography radionuclide imaging, CMR, or cardiac computed tomography is not recommended in patients with no change in clinical status and for whom no change in therapy is contemplated. | C | No benefit |
| 72 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | An arterial graft should not be used to bypass the right coronary artery with less than a critical stenosis (<90%). | C | Harm |
| 73 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | CABG or PCI to improve symptoms should not be performed in patients who do not meet anatomic (>50% left main or >70% non–left main stenosis) or physiological (eg, abnormal fractional flow reserve) criteria for revascularization. | C | Harm |
| 74 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | CABG should not be performed in patients with end-stage renal disease whose life expectancy is limited by noncardiac issues. | C | Harm |
| 75 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | CABG should not be performed in patients with ventricular tachycardia with scar and no evidence of ischemia. | C | Harm |
| 76 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Emergency CABG should not be performed after failed PCI if revascularization is impossible because of target anatomy or a no-reflow state. | C | Harm |
| 77 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Emergency CABG should not be performed after failed PCI in the absence of ischemia or threatened occlusion. | C | Harm |
| 78 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Emergency CABG should not be performed in patients with noreflow (successful epicardial reperfusion with unsuccessful microvascular reperfusion). | C | Harm |
| 79 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Emergency CABG should not be performed in patients with persistent angina and a small area of viable myocardium who are stable hemodynamically. | C | Harm |
| 80 | CABG | 2011 | ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Routine use of early extubation strategies in facilities with limited backup for airway emergencies or advanced respiratory support is potentially harmful. | C | Harm |
| 81 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Aortic valve balloon dilation is not indicated in children with isolated valvar AS who also have a degree of aortic regurgitation that warrants surgical aortic valve replacement or repair. | C | N/A |
| 82 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Aortic valvuloplasty is not indicated in children with isolated valvar AS who have a resting peak systolic valve gradient (by catheter) of <40 mm Hg† and who have no symptoms or ST-T-wave changes on electrocardiography. | C | N/A |
| 83 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Ductal stenting should not be performed in an infant with cyanotic CHD who has obvious proximal pulmonary artery stenosis in the vicinity of the ductal insertion. | C | N/A |
| 84 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Pulmonary venous angioplasty and stenting should not be considered in the management of pulmonary vein stenosis associated with other CHD that requires surgical intervention. | C | N/A |
| 85 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter ASD closure is contraindicated in the management of patients with a secundum ASD and advanced pulmonary vascular obstructive disease. | C | N/A |
| 86 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter ASD closure should not be performed with currently available devices in patients with ASDs other than those of the secundum variety. This would include defects of septum primum, sinus venosus defects, and unroofed coronary sinus defects. | C | N/A |
| 87 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter coil or device occlusion of a BTS (or Potts or Waterston shunt) is not recommended before the cardiac defect has been corrected if the patient develops unsatisfactory hypoxemia with balloon occlusion of the shunt. | C | N/A |
| 88 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter device occlusion is not indicated for patients with clinically insignificant coronary arteriovenous fistulae (eg, normal-sized cardiac chambers). | C | N/A |
| 89 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter device occlusion of a PVL is contraindicated when it is determined that there is inadequate space in which to seat the device without impairing valvar function. | C | N/A |
| 90 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter device occlusion of PVLs is not recommended for a small (hemodynamically insignificant) PVL or when hemolysis is mild or nonexistent. | C | N/A |
| 91 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter occlusion is not recommended for patients with pulmonary atresia with aortopulmonary collaterals that can be unifocalized into native pulmonary arteries. | C | N/A |
| 92 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter occlusion is not recommended for the presence of aortopulmonary collaterals of any size in biventricle or single-ventricle patients who have significant cyanosis due to decreased pulmonary flow. | C | N/A |
| 93 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Transcatheter PDA occlusion should not be attempted in a patient with a PDA with severe pulmonary hypertension associated with bidirectional or right-to-left shunting that is unresponsive to pulmonary vasodilator therapy. | C | N/A |
| 94 | Cardiac catheterization and intervention in pediatric cardiac disease | 2011 | Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease | Venovenous collaterals that drain below the diaphragm in a patient scheduled to undergo Fontan completion need not be embolized. | C | N/A |
| 95 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Revascularization is not recommended for patients with asymptomatic FMD of a carotid artery, regardless of the severity of stenosis. | C | No benefit |
| 96 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Asymptomatic patients with asymmetrical upper limb BP, periclavicular bruit, or flow reversal in a vertebral artery caused by subclavian artery stenosis should not undergo revascularization unless the internal mammary artery is required for myocardial revascularization. | C | No benefit |
| 97 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Carotid duplex ultrasonography is not recommended for patients without risk factors for atherosclerotic carotid disease and no disease on initial vascular testing. | C | No benefit |
| 98 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Carotid duplex ultrasonography is not recommended for routine evaluation of patients with neurological or psychiatric disorders unrelated to focal cerebral ischemia. | C | No benefit |
| 99 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Carotid duplex ultrasonography is not recommended for routine screening of asymptomatic patients who have no risk factors for atherosclerosis. | C | No benefit |
| 100 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Except in extraordinary circumstances, carotid revascularization by either CEA or CAS is not recommended for patients with severe disability caused by cerebral infarction that precludes preservation of useful function. | C | No benefit |
| 101 | Extracranial carotid and vertebral artery disease | 2011 | Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease | Reoperative CEA or CAS should not be performed in asymptomatic patients with less than 70% carotid stenosis that has remained stable. | C | Harm |
| 102 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | For women with advanced heart failure symptoms and HCM, pregnancy is associated with excess morbidity/mortality. | C | Harm |
| 103 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Heart transplantation should not be performed in mildly symptomatic patients of any age with HCM. | C | Harm |
| 104 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Invasive electrophysiologic testing as routine SCD risk stratification for patients with HCM should not be performed. | C | Harm |
| 105 | Hypertophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverter-defibrillator for high-risk status. | C | Harm |
| 106 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Alcohol septal ablation should not be done in patients with HCM who are less than 21 years of age and is discouraged in adults less than 40 years of age if myectomy is a viable option. | C | Harm |
| 107 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Alcohol septal ablation should not be done in patients with HCM with concomitant disease that independently warrants surgical correction (eg, coronary artery bypass grafting for CAD, mitral valve repair for ruptured chordae) in whom surgical myectomy can be performed as part of the operation. | C | Harm |
| 108 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | ICD placement as a routine strategy in patients with HCM without an indication of increased risk is potentially harmful. | C | Harm |
| 109 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | ICD placement as a strategy to permit patients with HCM to participate in competitive athletics is potentially harmful. | C | Harm |
| 110 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | ICD placement in patients who have an identified HCM genotype in the absence of clinical manifestations of HCM is potentially harmful. | C | Harm |
| 111 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Mitral valve replacement for relief of LVOT obstruction should not be performed in patients with HCM in whom septal reduction therapy is an option. | C | Harm |
| 112 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Nifedipine or other dihydropyridine calcium channel-blocking drugs are potentially harmful for treatment of symptoms (angina or dyspnea) in patients with HCM who have resting or provocable LVOT obstruction. | C | Harm |
| 113 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Permanent pacemaker implantation for the purpose of reducing gradient should not be performed in patients with HCM who are asymptomatic or whose symptoms are medically controlled. | C | No benefit |
| 114 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Septal reduction therapy should not be done for adult patients with HCM who are asymptomatic with normal exercise tolerance or whose symptoms are controlled or minimized on optimal medical therapy. | C | Harm |
| 115 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Septal reduction therapy should not be done unless performed as part of a program dedicated to the longitudinal and multidisciplinary care of patients with HCM. | C | Harm |
| 116 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Verapamil is potentially harmful in patients with obstructive HCM in the setting of systemic hypotension or severe dyspnea at rest. | C | Harm |
| 117 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Assessment for the presence of blunted flow reserve (microvascular ischemia) using quantitative myocardial blood flow measurements by PET is not indicated for the assessment of prognosis in patients with HCM. | C | No benefit |
| 118 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | In patients with HCM with resting or provocable outflow tract obstruction, regardless of symptom status, pure vasodilators and high-dose diuretics are potentially harmful. | C | Harm |
| 119 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Routine SPECT MPI or stress echocardiography is not indicated for detection of “silent” CAD-related ischemia in patients with HCM who are asymptomatic. | C | No benefit |
| 120 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Routine TEE and/or contrast echocardiography is not recommended when TTE images are diagnostic of HCM and/or there is no suspicion of fixed obstruction or intrinsic mitral valve pathology. | C | No benefit |
| 121 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | Septal reduction therapy should not be performed for asymptomatic adult and pediatric patients with HCM with normal effort tolerance regardless of the severity of obstruction. | C | Harm |
| 122 | Hypertrophic cardiomyopathy | 2011 | ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy | TTE studies should not be performed more frequently than every 12 months in patients with HCM when it is unlikely that any changes have occurred that would have an impact on clinical decision making. | C | No benefit |
| 123 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | A strategy of coronary angiography with intent to perform PCI is not recommended in patients with STEMI in whom the risks of revascularization are likely to outweigh the benefits or when the patient or designee does not want invasive care. | C | No benefit |
| 124 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | An early invasive strategy (ie, diagnostic angiography with intent to perform revascularization) is not recommended in patients with extensive comorbidities (eg, liver or pulmonary failure, cancer) in whom the risks of revascularization and comorbid conditions are likely to outweigh the benefits of revascularization, there is a low likelihood of ACS despite acute chest pain, or consent to revascularization will not be granted regardless of the findings. | C | No benefit |
| 125 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | CABG or PCI to improve symptoms should not be performed in patients who do not meet anatomic (≥50% left main or ≥70% non–left main stenosis) or physiological (eg, abnormal fractional flow reserve) criteria for revascularization. | C | Harm |
| 126 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Fondaparinux should not be used as the sole anticoagulant to support PCI. An additional anticoagulant with anti-IIa activity should be administered because of the risk of catheter thrombosis. | C | Harm |
| 127 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | In patients with a prior history of allergic reactions to shellfish or seafood, anaphylactoid prophylaxis for contrast reaction is not beneficial. | C | No benefit |
| 128 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | It is not recommended that elective/urgent PCI be performed by low-volume operators (<75 procedures per year) at low-volume centers (200 to 400 procedures per year) with or without on-site cardiac surgery. An institution with a volume of fewer than 200 procedures per year, unless in a region that is underserved because of geography, should carefully consider whether it should continue to offer this service. | C | No benefit |
| 129 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | IVUS for routine lesion assessment is not recommended when revascularization with PCI or CABG is not being contemplated. | C | No benefit |
| 130 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | PCI is not recommended for chronic saphenous vein graft occlusions. | C | Harm |
| 131 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Primary or elective PCI should not be performed in hospitals without on-site cardiac surgery capabilities without a proven plan for rapid transport to a cardiac surgery operating room in a nearby hospital or without appropriate hemodynamic support capability for transfer. | C | Harm |
| 132 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Routine periodic stress testing of asymptomatic patients after PCI without specific clinical indications should not be performed. | C | No benefit |
| 133 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | Routine use of a proton pump inhibitor is not recommended for patients at low risk of gastrointestinal bleeding, who have much less potential to benefit from prophylactic therapy. | C | No benefit |
| 134 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | The routine clinical use of genetic testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended. | C | No benefit |
| 135 | PCI | 2011 | ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention | The routine clinical use of platelet function testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended. | C | No benefit |
| 136 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Dosing with vitamin K antagonists on the basis of pharmacogenetics is not recommended at this time. | C | N/A |
| 137 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Genetic screening of the general population for prevention of a first stroke is not recommended. | C | N/A |
| 138 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Noninvasive screening for unruptured intracranial aneurysms in patients with 1 relative with SAH or intracranial aneurysms is not recommended. | C | N/A |
| 139 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | OCs may be harmful in women with additional risk factors (eg, cigarette smoking, prior thromboembolic events). | C | N/A |
| 140 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Screening of patients at risk for myopathy in the setting of statin use is not recommended when considering initiation of statin therapy at this time. | C | N/A |
| 141 | Primary prevention of stroke | 2011 | Guidelines for the Primary Prevention of Stroke | Universal screening for intracranial aneurysms in carriers of mutations for Mendelian disorders associated with aneurysm is not recommended. | C | N/A |
| 142 | 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 as an adjuvant to anticoagulation and systemic fibrinolysis in the treatment of acute PE. | C | N/A |
| 143 | VTE | 2011 | Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension | Catheter embolectomy and surgical thrombectomy are not recommended for patients with low-risk PE or submassive acute PE with minor RV dysfunction, minor myocardial necrosis, and no clinical worsening. | C | N/A |
| 144 | Aspirin for primary prevention in people with diabetes | 2010 | ADA/AHA/ACCF Aspirin for Primary Prevention of Cardiovascular Events in People With Diabetes | Aspirin should not be recommended for CVD prevention for adults with diabetes at low CVD risk (men under age 50 years and women under 60 years with no major additional CVD risk factors; 10-year CVD risk under 5%) as the potential adverse effects from bleeding offset the potential benefits. | C | Harm |
| 145 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | ACE Inhibitors and ARBs in the Hospital IV administration of ACE inhibitors is contraindicated in the first 24 hours because of risk of hypotension. | C | N/A |
| 146 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | NSAIDs (except for aspirin), both nonselective as well as COX-2 selective agents, should not be administered during hospitalization for STEMI because of the increased risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture associated with their use. | C | N/A |
| 147 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Patients initially treated with enoxaparin should not be switched to UFH and vice versa because of increased risk of bleeding. | C | N/A |
| 148 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | Statins should not be discontinued during the index hospitalization unless contraindicated. | C | N/A |
| 149 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | The use of inpatient-derived risk scoring systems are not recommended to identify patients who may be safely discharged from the ED. | C | N/A |
| 150 | CPR - ACS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Acute Coronary Syndromes | The use of nitrates in patients with hypotension (SBP <90 mm Hg or ≥30 mm Hg below baseline), extreme bradycardia (<50 bpm), or tachycardia in the absence of heart failure (>100 bpm) and in patients with right ventricular infarction is contraindicated. | C | N/A |
| 151 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | Adenosine should not be given for unstable or for irregular or polymorphic wide-complex tachycardias, as it may cause degeneration of the arrhythmia to VF. | C | N/A |
| 152 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | AV nodal blocking drugs (e.g. CCB or BB) should not be used for pre-excited atrial fibrillation or flutter. | C | N/A |
| 153 | CPR - Adult ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Advanced Cardiovascular Life Support | The routine use of cricoid pressure in cardiac arrest is not recommended. | C | N/A |
| 154 | CPR - Adult stroke | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Adult Stroke | Following stroke, unless the patient is hypotensive (systolic blood pressure <90 mm Hg), prehospital intervention for blood pressure is not recommended. | C | N/A |
| 155 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | During rescue breathing, attempts to remove water from the breathing passages by any means other than suction (eg, abdominal thrusts or the Heimlich maneuver) are unnecessary and potentially dangerous. The routine use of abdominal thrusts or the Heimlich maneuver for drowning victims is not recommended. | C | N/A |
| 156 | CPR - Cardiac arrest | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Cardiac Arrest | The effect of bolus administration of potassium for cardiac arrest suspected to be secondary to hypokalemia is unknown and ill advised. | C | N/A |
| 157 | CPR - CPR techniques and devices | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - CPR Techniques and Devices | Precordial thump should not be used for unwitnessed out-of-hospital cardiac arrest. | C | N/A |
| 158 | CPR - CPR techniques and devices | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - CPR Techniques and Devices | Rescuers should avoid using the automatic mode of the oxygen-powered, flow-limited resuscitator during CPR because it may generate high positive end-expiratory pressure (PEEP) that may impede venous return during chest compressions and compromise forward blood flow. | C | N/A |
| 159 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Among children with cocain toxicity do not give β-adrenergic blockers. | C | N/A |
| 160 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Among children with TCA or other sodium channel blocker toxicity, do not administer Class IA (quinidine, procainamide), Class IC (flecainide, propafenone), or Class III (amiodarone and sotalol) antiarrhythmics, which may exacerbate cardiac toxicity. | C | N/A |
| 161 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | An IV/IO dose of Verapamil, 0.1 to 0.3 mg/kg is effective in terminating SVT in older children, but it should not be used in infants without expert consultation because it may cause potential myocardial depression, hypotension, and cardiac arrest. | C | N/A |
| 162 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | Avoid delivering excessive ventilation during cardiac arrest. | C | N/A |
| 163 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | In cases of trauma, do not routinely hyperventilate even in case of head injury (Class III, LOE C).338,339 Intentional brief hyperventilation may be used as a temporizing rescue therapy if there are signs of impending brain herniation (eg, sudden rise in measured intracranial pressure, dilation of one or both pupils with decreased response to light, bradycardia, and hypertension). | C | N/A |
| 164 | CPR - Pediatric ACLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Advanced Life Support | There is insufficient evidence to recommend routine cricoid pressure application to prevent aspiration during endotracheal intubation in children. Do not continue cricoid pressure if it interferes with ventilation or the speed or ease of intubation. | C | N/A |
| 165 | CPR - Pediatric BLS | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Pediatric Basic Life Support | During bag-mask ventilation, avoid excessive ventilation. | C | N/A |
| 166 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | Active rewarming should be avoided in comatose patients who spontaneously develop a mild degree of hypothermia (>32°C [89.6°F]) after resuscitation from cardiac arrest during the first 48 hours after ROSC. | C | N/A |
| 167 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | Routine hyperventilation with hypocapnia should be avoided after ROSC because it may worsen global brain ischemia by excessive cerebral vasoconstriction | C | N/A |
| 168 | CPR - Post-cardiac arrest care | 2010 | AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science - Post–Cardiac Arrest Care | The absence of vestibulo-ocular reflexes at ≥24 hours (FPR 0%, 95% CI 0% to 14%) or Glasgow Coma Scale (GCS) score <5 at ≥72 hours (FPR 0%, 95% CI 0% to 6%) are less reliable for predicting poor outcome or were studied only in limited numbers of patients. Other clinical signs, including myoclonus, are not recommended for predicting poor outcome | C | N/A |
| 169 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | Do not administer anything by mouth for any poison ingestion unless advised to do so by a poison control center or emergency medical personnel because it may be harmful | C | N/A |
| 170 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | During electric injuries, do not place yourself in danger by touching an electrocuted victim while the power is on. Turn off the power at its source; at home the switch is usually near the fuse box. | C | N/A |
| 171 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | During injury emergencies, elevation and use of pressure points are not recommended to control bleeding. These unproven procedures may compromise the proven intervention of direct pressure, so they could be harmful. | C | N/A |
| 172 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | First aid providers should not use immobilization devices because their benefit in first aid has not been proven and they may be harmful. Immobilization devices may be needed in special circumstances when immediate extrication (eg, rescue of drowning victim) is required, but first aid providers should not use these devices unless they have been properly trained in their use. | C | N/A |
| 173 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | Following trauma, assume that any injury to an extremity includes a bone fracture. Cover open wounds with a dressing. Do not move or try to straighten an injured extremity. There is no evidence that straightening an angulated suspected long bone fracture shortens healing time or reduces pain prior to permanent fixation. | C | N/A |
| 174 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | In cases of frostbite, chemical warmers should not be placed directly on frostbitten tissue because they can reach temperatures that can cause burns | C | N/A |
| 175 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | In cases of frostbite, transport the victim to an advanced medical facility as rapidly as possible. Do not try to rewarm the frostbite if there is any chance that it might refreeze or if you are close to a medical facility. | C | N/A |
| 176 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | In jellyfish stings, ressure immobilization bandages are not recommended because animal studies show that pressure with an immobilization bandage causes further release of venom, even from already fired nematocysts. | C | N/A |
| 177 | First aid | 2010 | AHA and American Red Cross Guidelines for First Aid | In snakebites, do not apply suction as first aid. Suction does remove some venom, but the amount is very small. Suction has no clinical benefit and it may aggravate the injury. | C | N/A |
| 178 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Coronary computed tomography angiography is not recommended for cardiovascular risk assessment in asymptomatic adults. | C | No benefit |
| 179 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Echocardiography is not recommended for cardiovascular risk assessment of CHD in asymptomatic adults without hypertension. | C | No benefit |
| 180 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Magnetic resonance imaging for detection of vascular plaque is not recommended for cardiovascular risk assessment in asymptomatic adults. | C | No benefit |
| 181 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Measures of arterial stiffness outside of research settings are not recommended for cardiovascular risk assessment in asymptomatic adults. | C | No benefit |
| 182 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Stress MPI is not indicated for cardiovascular risk assessment in low- or intermediate-risk asymptomatic adults. (Exercise or pharmacologic stress MPI is primarily used and studied for its role in advanced cardiac evaluation of symptoms suspected of representing CHD and/or estimation of prognosis in patients with known coronary artery disease. | C | No benefit |
| 183 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Measurement of lipid parameters, including lipoproteins, apolipoproteins, particle size, and density, beyond a standard fasting lipid profile is not recommended for cardiovascular risk assessment in asymptomatic adults. | C | No benefit |
| 184 | Risk assessment in asymptomatic adults | 2010 | ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults | Stress echocardiography is not indicated for cardiovascular risk assessment in low- or intermediate-risk asymptomatic adults. (Exercise or pharmacologic stress echocardiography is primarily used for its role in advanced cardiac evaluation of symptoms suspected of representing CHD and/or estimation of prognosis in patients with known coronary artery disease or the assessment of patients with known or suspected valvular heart disease.) | C | No benefit |
| 185 | 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 | A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening. | C | N/A |
| 186 | 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 | Regional anesthetic techniques are not recommended in patients at risk of neuraxial hematoma formation due to thienopyridine antiplatelet therapy, low-molecular-weight heparins, or clinically significant anticoagulation. | C | N/A |
| 187 | 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 | Routinely changing double-lumen endotracheal (endobronchial) tubes to single-lumen tubes at the end of surgical procedures complicated by significant upper airway edema or hemorrhage is not recommended. | C | N/A |
| 188 | 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 | Vasodilator therapy should not be initiated prior to rate control so as to avoid associated reflex tachycardia that may increase aortic wall stress, leading to propagation or expansion of a thoracic aortic dissection. | C | N/A |
| 189 | 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 | A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening. | C | N/A |
| 190 | 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 | Vasodilator therapy should not be initiated prior to rate control so as to avoid associated reflex tachycardia that may increase aortic wall stress, leading to propagation or expansion of a thoracic aortic dissection. | C | N/A |
| 191 | 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 | Regional anesthetic techniques are not recommended in patients at risk of neuraxial hematoma formation due to thienopyridine antiplatelet therapy, low-molecular-weight heparins, or clinically significant anticoagulation. | C | N/A |
| 192 | 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 | Routinely changing double-lumen endotracheal (endobronchial) tubes to single-lumen tubes at the end of surgical procedures complicated by significant upper airway edema or hemorrhage is not recommended. | C | N/A |
| 193 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Prophylaxis against infective endocarditis (IE) is not recommended for nondental procedures (such as esophagogastroduodenoscopy or colonoscopy) in the absence of active infection. | C | N/A |
| 194 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Balloon valvotomy is not recommended for asymptomatic patients with a peak instantaneous gradient by Doppler less than 50 mm Hg in the presence of normal cardiac output. | C | N/A |
| 195 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Balloon valvotomy is not recommended for symptomatic patients with a peak instantaneous gradient by Doppler less than 30 mm Hg. | C | N/A |
| 196 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Balloon valvotomy is not recommended for symptomatic patients with PS and severe pulmonary regurgitation. | C | N/A |
| 197 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Cardiac catheterization is unnecessary for diagnosis of valvular PS and should be used only when percutaneous catheter intervention is contemplated. | C | N/A |
| 198 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Endocarditis prophylaxis is not recommended for those with a repaired PDA without residual shunt. | C | N/A |
| 199 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Estrogen-containing contraceptives should be avoided. | C | N/A |
| 200 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Exercise stress testing should not be performed in symptomatic patients with AS or those with repolarization abnormality on ECG or systolic dysfunction on echocardiography. | C | N/A |
| 201 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Patients with small, asymptomatic CAVF should not undergo closure of CAVF. | C | N/A |
| 202 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | PDA closure is not indicated for patients with PAH and net right-to-left shunt. | C | N/A |
| 203 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Pregnancy should not be planned without consultation and evaluation at a comprehensive ACHD center with experience and expertise in maternal and prenatal management of complex CHD. | C | N/A |
| 204 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Repeated routine phlebotomies are not recommended because of the risk of iron depletion, decreased oxygen carrying capacity, and stroke. | C | N/A |
| 205 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | Surgical intervention is not recommended to prevent AR for patients with SubAS if the patient has trivial LVOT obstruction or trivial to mild AR. | C | N/A |
| 206 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | The estrogen-containing oral contraceptive pill is not recommended in ACHD patients at risk of thromboembolism, such as those with cyanosis related to an intracardiac shunt, severe PAH, or Fontan repair. | C | N/A |
| 207 | Congenital heart disease | 2008 | ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease | The use of single-barrier contraception alone in women with CHD-PAH is not recommended owing to the frequency of failure. | C | N/A |
| 208 | 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 either LV systolic function or mild to moderate LV diastolic dysfunction who is otherwise a candidate for AVR. | C | N/A |
| 209 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | CRT is not indicated for patients whose functional status and life expectancy are limited predominantly by chronic noncardiac conditions. | C | N/A |
| 210 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD implantation is not indicated in pediatric patients and patients with congenital heart disease. | C | N/A |
| 211 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for NYHA Class IV patients with drug-refractory congestive heart failure who are not candidates for cardiac transplantation or CRT-D. | C | N/A |
| 212 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for patients who do not have a reasonable expectation of survival with an acceptable functional status for at least 1 year, even if they meet ICD implantation criteria specified in the Class I, IIa, and IIb recommendations. | C | N/A |
| 213 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for patients with incessant VT or VF. | C | N/A |
| 214 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated for syncope of undetermined cause in a patient without inducible ventricular tachyarrhythmias and without structural heart disease. | C | N/A |
| 215 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated in patients with significant psychiatric illnesses that may be aggravated by device implantation or that may preclude systematic follow-up. | C | N/A |
| 216 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | ICD therapy is not indicated when VF or VT is amenable to surgical or catheter ablation (e.g., atrial arrhythmias associated with the Wolff-Parkinson-White syndrome, RV or LV outflow tract VT, idiopathic VT, or fascicular VT in the absence of structural heart disease). | C | N/A |
| 217 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic bifascicular block with or without first-degree AV block after surgery for congenital heart disease in the absence of prior transient complete AV block. | C | N/A |
| 218 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic sinus bradycardia with the longest relative risk interval less than 3 seconds and a minimum heart rate more than 40 bpm. | C | N/A |
| 219 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic type I second-degree AV block at the supra-His (AV node) level or that which is not known to be intra- or infra-Hisian. | C | N/A |
| 220 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for asymptomatic type I second-degree AV block. | C | N/A |
| 221 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for patients who are asymptomatic or whose symptoms are medically controlled. | C | N/A |
| 222 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for SND in asymptomatic patients. | C | N/A |
| 223 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for SND in patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia. | C | N/A |
| 224 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for SND with symptomatic bradycardia due to nonessential drug therapy. | C | N/A |
| 225 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacemaker implantation is not indicated for symptomatic patients without evidence of LV outflow tract obstruction. | C | N/A |
| 226 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for a hypersensitive cardioinhibitory response to carotid sinus stimulation without symptoms or with vague symptoms. | C | N/A |
| 227 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for frequent or complex ventricular ectopic activity without sustained VT in the absence of the long-QT syndrome. | C | N/A |
| 228 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated for situational vasovagal syncope in which avoidance behavior is effective and preferred. | C | N/A |
| 229 | Device-based therapy | 2008 | ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities | Permanent pacing is not indicated in the presence of an accessory pathway that has the capacity for rapid anterograde conduction. | C | N/A |
| 230 | Endomyocardial biopsy | 2008 | The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease | Endomyocardial biopsy should not be performed in the setting of unexplained atrial fibrillation. | C | N/A |
| 231 | Noninvasive coronary artery imaging | 2008 | Noninvasive Coronary Artery Imaging Magnetic Resonance Angiography and Multidetector Computed Tomography Angiography | Neither coronary CTA nor MRA should be used to screen for coronary artery disease in patients who have no signs or symptoms suggestive of coronary artery disease. | C | N/A |
| 232 | Noninvasive coronary artery imaging | 2008 | Noninvasive Coronary Artery Imaging Magnetic Resonance Angiography and Multidetector Computed Tomography Angiography | patients with a high pretest likelihood of coronary stenoses are likely to require intervention and invasive catheter angiography for definitive evaluation; thus, CTA is not recommended for those individuals. | C | N/A |
| 233 | Prevention of infective endocarditis | 2008 | AHA Guideline for the Prevention of Infective Endocarditis | There is no evidence that coronary artery bypass graft surgery is associated with a long-term risk for infection. Therefore, antibiotic prophylaxis for dental procedures is not needed for individuals who have undergone this surgery. Antibiotic prophylaxis for dental procedures is not recommended for patients with coronary artery stents. | C | N/A |
| 234 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | In diagnosing patients with heart failure, blood BNP or NT-proBNP testing should not be used to replace conventional clinical evaluation or assessment of the degree of left ventricular structural or functional abnormalities (eg, echocardiography, invasive hemodynamic assessment). | C | No benefit |
| 235 | Biomarkers in HF | 2007 | Practice Guidelines Clinical Utilization of Cardiac Biomarker Testing in Heart Failure | In diagnosing patients with heart failure, routine blood BNP or NT-proBNP testing for patients with an obvious clinical diagnosis of heart failure is not recommended. | C | No benefit |
| 236 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Heart transplantation for pediatric heart disease is not efficacious when heart disease is associated with severe, irreversible disease in other organ systems or when it is part of a severe, irreversible, multisystemic disease process. Multiorgan transplantation may be considered. | C | N/A |
| 237 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Heart transplantation is generally not indicated in adults with previously repaired or palliated congenital heart disease with a peak maximal oxygen consumption of >15 mL · kg−1 · min−1 or >50% predicted for age and sex without other indications. | C | N/A |
| 238 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Heart transplantation is not feasible in the presence of severe hypoplasia of the central branch pulmonary arteries or pulmonary veins. | C | N/A |
| 239 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Heart transplantation should not be performed in adults with previously repaired or palliated congenital heart disease in whom comorbidities exist that would otherwise preclude heart transplantation in adults. | C | N/A |
| 240 | Heart transplant in pediatric patients | 2007 | Indications for Heart Transplantation in Pediatric Heart Disease | Orthotopic heart transplantation for pediatric heart disease is not efficacious when heart disease is associated with severe, irreversible, fixed elevation of pulmonary vascular resistance. | C | N/A |
| 241 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | Application of management guidelines for ACS should not be based solely on measurement of CRP. | C | N/A |
| 242 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | Application of management guidelines for ACS should not be based solely on measurement of natriuretic peptides. | C | N/A |
| 243 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | Biomarkers of necrosis should not be used for routine screening of patients with low clinical probability of ACS. | C | N/A |
| 244 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | For patients with diagnostic ECG abnormalities on presentation (e.g., new ST-segment elevation), diagnosis and treatment should not be delayed while awaiting biomarker results. | C | N/A |
| 245 | Standardization of biomarkers in ACS | 2007 | Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines - Analytical Issues for Biochemical Markers of Acute Coronary Syndromes | Total CK, CK-MB activity, aspartate aminotransferase (AST, SGOT), β-hydroxybutyric dehydrogenase, and/or lactate dehydrogenase should not be used as biomarkers for the diagnosis of MI. | C | N/A |
| 246 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | CT coronary angiography is not recommended in asymptomatic persons for the assessment of occult CAD | C | N/A |
| 247 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | Imaging of patients to follow up stent placement cannot be recommended | C | N/A |
| 248 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | It is not recommended to use CACP measure in asymptomatic persons to establish the presence of obstructive disease for subsequent revascularization | C | N/A |
| 249 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | The incremental benefit of hybrid imaging strategies will need to be demonstrated before clinical implementation, as radiation exposure may be significant with dual nuclear/CT imaging. Therefore, hybrid nuclear/CT imaging is not recommended | C | N/A |
| 250 | CT for CAD | 2006 | Assessment of Coronary Artery Disease by Cardiac Computed Tomography | There are limited data on variability but none on the prognostic implications of CT angiography for NCP assessment or on the utility of these measures to track atherosclerosis or stenosis over time; therefore, their use for these purposes is not recommended | C | N/A |
| 251 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Ablation is not indicated in young patients with asymptomatic NSVT and normal ventricular function. | C | N/A |
| 252 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Ablation of asymptomatic relatively infrequent PVCs is not indicated. | C | N/A |
| 253 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Calcium channel blockers such as verapamil and diltiazem should not be used in patients to terminate wide-QRS-complex tachycardia of unknown origin, especially in patients with a history of myocardial dysfunction. | C | N/A |
| 254 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Digoxin or verapamil should not be used for treatment of sustained tachycardia in infants when VT has not been excluded as a potential diagnosis. | C | N/A |
| 255 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Elderly patients with projected life expectancy less than 1 y due to major comorbidities should not receive ICD therapy. | C | N/A |
| 256 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | ICD implantation is not indicated during the acute phase of myocarditis. | C | N/A |
| 257 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Pharmacological treatment of isolated PVCs in pediatric patients is not recommended. | C | N/A |
| 258 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Prolonged, unbalanced, very low calorie, semistarvation diets are not recommended; they may be harmful and provoke life-threatening ventricular arrhythmias. | C | N/A |
| 259 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Prophylactic antiarrhythmic therapy generally is not indicated for primary prevention of SCD in patients with pulmonary arterial hypertension (PAH) or other pulmonary conditions. | C | N/A |
| 260 | Ventricular arrhythmias | 2006 | ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death | Prophylactic antiarrhythmic therapy is not indicated for asymptomatic patients with congenital heart disease and isolated PVCs. | C | N/A |
| 261 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Oral anticoagulation therapy with warfarin is not indicated to reduce the risk of adverse cardiovascular ischemic events in individuals with atherosclerotic lower extremity PAD. | C | N/A |
| 262 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Arterial imaging is not indicated for patients with a normal postexercise ABI. This does not apply if other atherosclerotic causes (e.g., entrapment syndromes or isolated internal iliac artery occlusive disease) are suspected. | C | N/A |
| 263 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Primary stent placement is not recommended in the femoral, popliteal, or tibial arteries. | C | N/A |
| 264 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Surgical and endovascular intervention is not indicated in patients with severe decrements in limb perfusion (e.g., ABI less than 0.4) in the absence of clinical symptoms of CLI. | C | N/A |
| 265 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Vitamin E is not recommended as a treatment for patients with intermittent claudication. | C | N/A |
| 266 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Captopril renal scintigraphy is not recommended as a screening test to establish the diagnosis of RAS. | C | N/A |
| 267 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Endovascular intervention is not indicated as prophylactic therapy in an asymptomatic patient with lower extremity PAD. | C | N/A |
| 268 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Endovascular intervention is not indicated if there is no significant pressure gradient across a stenosis despite flow augmentation with vasodilators. | C | N/A |
| 269 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | Femoral-tibial artery bypasses with synthetic graft material should not be used for the treatment of claudication. | C | N/A |
| 270 | Peripheral arterial disease | 2005 | ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) | In contrast to chronic intestinal ischemia, duplex sonography of the abdomen is not an appropriate diagnostic tool for suspected acute intestinal ischemia. | C | N/A |
| 271 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Amiodarone is not indicated as prophylactic therapy for patients with SVT during pregnancy. | C | N/A |
| 272 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Beta blockers are not indicated among patients with wide QRS-complex tachycardia of unknown origin. | C | N/A |
| 273 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Catheter ablation is not indicated as prophylactic therapy for patients with non-sustained and asymptomatic focal atrial tachycardia. | C | N/A |
| 274 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Closure of unrepaired asymptomatic ASD that is not associated with significant hemodynamic changes is not recommended to treat SVT in adults with congenital heart disease. | C | N/A |
| 275 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Digoxin is not indicated among patients with single or infrequent AVRT episode(s) with no pre-excitation. | C | N/A |
| 276 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Verapamil, diltiazem, or digoxin is not indicated among patients with AVRT that is poorly tolerated with no pre-excitation. | C | N/A |
| 277 | Supraventricular arrhythmias | 2003 | ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias | Verapamil, diltiazem, or digoxin is not indicated among patients with WPW syndrome, with pre-excitation and symptomatic arrhythmias that are well-tolerated. | C | N/A |