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| __NOTOC__
| | #Redirect [[Congestive heart failure clinical assessment]] |
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| | [[File:Siren.gif|30px|link=Heart failure resident survival guide]]|| <br> || <br>
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| | [[Heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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| {{Congestive heart failure}}
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| {{CMG}}
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| == 2013 ACCF/AHA Guideline/2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) <ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= | issue= | pages= | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642 }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID:[http://pubmed.gov/19324967 19324967]</ref>==
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| ===Initial and Serial Evaluation of the HF Patient (DO NOT EDIT)<ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= | issue= | pages= | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642 }} </ref>===
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| |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A thorough history and physical examination should be obtained/performed in patients presenting with [[HF]] to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In patients with idiopathic [[DCM]], a 3-generational family history should be obtained to aid in establishing the diagnosis of familial [[DCM]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C ]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of [[jugular venous pressure]] and the presence of [[peripheral edema]] or [[orthopnea]].<ref name="pmid8409071">{{cite journal| author=Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E| title=Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. | journal=J Am Coll Cardiol | year= 1993 | volume= 22 | issue= 4 | pages= 968-74 | pmid=8409071 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8409071 }} </ref><ref name="pmid2913385">{{cite journal| author=Stevenson LW, Perloff JK| title=The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. | journal=JAMA | year= 1989 | volume= 261 | issue= 6 | pages= 884-8 | pmid=2913385 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2913385 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B ]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Initial laboratory evaluation of patients presenting with [[HF]] should include [[complete blood count]], [[urinalysis]], serum electrolytes (including [[calcium]] and [[magnesium]]), [[blood urea nitrogen]], serum [[creatinine]], [[glucose]], fasting [[lipid profile]], [[liver function tests]], and [[thyroid-stimulating hormone]]. Serial monitoring, when indicated, should include serum electrolytes and renal function. A 12-lead [[ECG]] should be performed initially on all patients presenting with [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' In ambulatory patients with dyspnea, measurement of [[B-type natriuretic peptide|BNP]] or [[B-type natriuretic peptide|N-terminal pro-B-type natriuretic peptide (NT-proBNP)]] is useful to support clinical decision making regarding the diagnosis of [[HF]], especially in the setting of clinical uncertainty.<ref name="pmid16412859">{{cite journal| author=Costello-Boerrigter LC, Boerrigter G, Redfield MM, Rodeheffer RJ, Urban LH, Mahoney DW et al.| title=Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: determinants and detection of left ventricular dysfunction. | journal=J Am Coll Cardiol | year= 2006 | volume= 47 | issue= 2 | pages= 345-53 | pmid=16412859 | doi=10.1016/j.jacc.2005.09.025 | pmc=PMC2647136 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16412859 }} </ref><ref name="pmid12215132">{{cite journal| author=Vasan RS, Benjamin EJ, Larson MG, Leip EP, Wang TJ, Wilson PW et al.| title=Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham heart study. | journal=JAMA | year= 2002 | volume= 288 | issue= 10 | pages= 1252-9 | pmid=12215132 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12215132 }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'', Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic [[HF]].<ref name="pmid14662703">{{cite journal| author=Tang WH, Girod JP, Lee MJ, Starling RC, Young JB, Van Lente F et al.| title=Plasma B-type natriuretic peptide levels in ambulatory patients with established chronic symptomatic systolic heart failure. | journal=Circulation | year= 2003 | volume= 108 | issue= 24 | pages= 2964-6 | pmid=14662703 | doi=10.1161/01.CIR.0000106903.98196.B6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14662703 }} </ref><ref name="pmid12021226">{{cite journal| author=Berger R, Huelsman M, Strecker K, Bojic A, Moser P, Stanek B et al.| title=B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. | journal=Circulation | year= 2002 | volume= 105 | issue= 20 | pages= 2392-7 | pmid=12021226 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12021226 }} </ref><ref name="pmid18634981">{{cite journal| author=Neuhold S, Huelsmann M, Strunk G, Stoiser B, Struck J, Morgenthaler NG et al.| title=Comparison of copeptin, B-type natriuretic peptide, and amino-terminal pro-B-type natriuretic peptide in patients with chronic heart failure: prediction of death at different stages of the disease. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 4 | pages= 266-72 | pmid=18634981 | doi=10.1016/j.jacc.2008.03.050 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18634981 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' Patients with suspected or new-onset [[HF]], or those presenting with acute decompensated [[HF]], should undergo a chest x-ray to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient’s symptoms. A 2-dimensional echocardiogram with Doppler should be performed during initial evaluation of patients presenting with [[HF]] to assess ventricular function, size, wall thickness, wall motion, and valve function. Repeat measurement of [[EF]] and measurement of the severity of structural remodeling are useful to provide information in patients with HF who have had a significant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a significant effect on cardiac function; or who may be candidates for device therapy.'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' Invasive hemodynamic monitoring with a pulmonary artery catheter should be performed to guide therapy in patients who have respiratory distress or clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
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| |bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should not be performed.<ref name="pmid22547398">{{cite journal| author=Beller GA| title=Tests that may be overused or misused in cardiology: the Choosing Wisely campaign. | journal=J Nucl Cardiol | year= 2012 | volume= 19 | issue= 3 | pages= 401-3 | pmid=22547398 | doi=10.1007/s12350-012-9569-y | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22547398 }} </ref><ref name="pmid21338862">{{cite journal| author=American College of Cardiology Foundation Appropriate Use Criteria Task Force. American Society of Echocardiography. American Heart Association. American Society of Nuclear Cardiology. Heart Failure Society of America. Heart Rhythm Society et al.| title=ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. | journal=J Am Soc Echocardiogr | year= 2011 | volume= 24 | issue= 3 | pages= 229-67 | pmid=21338862 | doi=10.1016/j.echo.2010.12.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21338862 }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| |bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Routine use of invasive hemodynamic monitoring is not recommended in normotensive patients with acute decompensated HF and congestion with symptomatic response to diuretics and vasodilators.<ref name="pmid16204662">{{cite journal| author=Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G et al.| title=Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. | journal=JAMA | year= 2005 | volume= 294 | issue= 13 | pages= 1625-33 | pmid=16204662 | doi=10.1001/jama.294.13.1625 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16204662 }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (harm)
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| |bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Endomyocardial biopsy should not be performed in the routine evaluation of patients with HF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) ''<nowiki>"</nowiki>
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| | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1. '''Validated multivariable risk scores can be useful to estimate subsequent risk of mortality in ambulatory or hospitalized patients with [[HF]].<ref name="pmid9193435">{{cite journal| author=Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM| title=Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. | journal=Circulation | year= 1997 | volume= 95 | issue= 12 | pages= 2660-7 | pmid=9193435 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9193435 }} </ref><ref name="pmid19168876">{{cite journal| author=Wedel H, McMurray JJ, Lindberg M, Wikstrand J, Cleland JG, Cornel JH et al.| title=Predictors of fatal and non-fatal outcomes in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA): incremental value of apolipoprotein A-1, high-sensitivity C-reactive peptide and N-terminal pro B-type natriuretic peptide. | journal=Eur J Heart Fail | year= 2009 | volume= 11 | issue= 3 | pages= 281-91 | pmid=19168876 | doi=10.1093/eurjhf/hfn046 | pmc=PMC2645061 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19168876 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Screening for hemochromatosis or HIV is reasonable in selected patients who present with [[HF]].<ref name="pmid21903058">{{cite journal| author=Okonko DO, Mandal AK, Missouris CG, Poole-Wilson PA| title=Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anemia, exercise capacity, and survival. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 12 | pages= 1241-51 | pmid=21903058 | doi=10.1016/j.jacc.2011.04.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21903058 }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Diagnostic tests for rheumatologic diseases, [[amyloidosis]], or [[pheochromocytoma]] are reasonable inpatients presenting with [[HF]] in whom there is a clinical suspicion of these diseases.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' [[B-type natriuretic peptide|BNP]] or [[B-type natriuretic peptide|N-terminal pro-B-type natriuretic peptide (NT-proBNP)]]-guided [[HF]] therapy can be useful to achieve optimal dosing of GDMT in select clinically euvolemic patients followed in a well-structured [[HF]] disease management program.<ref name="pmid22018299">{{cite journal| author=Januzzi JL, Rehman SU, Mohammed AA, Bhardwaj A, Barajas L, Barajas J et al.| title=Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 18 | pages= 1881-9 | pmid=22018299 | doi=10.1016/j.jacc.2011.03.072 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22018299 }} </ref><ref name="pmid20117364">{{cite journal| author=Lainchbury JG, Troughton RW, Strangman KM, Frampton CM, Pilbrow A, Yandle TG et al.| title=N-terminal pro-B-type natriuretic peptide-guided treatment for chronic heart failure: results from the BATTLESCARRED (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) trial. | journal=J Am Coll Cardiol | year= 2009 | volume= 55 | issue= 1 | pages= 53-60 | pmid=20117364 | doi=10.1016/j.jacc.2009.02.095 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20117364 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404373 Review in: Ann Intern Med. 2010 Apr 20;152(8):JC4-4] </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' Noninvasive imaging to detect myocardial ischemia and viability is reasonable in patients presenting with de novo [[HF]] who have known [[CAD]] and no angina unless the patient is not eligible for revascularization of any kind. Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.''' Viability assessment is reasonable in select situations when planning revascularization in [[HF]] patients with CAD.<ref name="pmid19443475">{{cite journal| author=Rizzello V, Poldermans D, Biagini E, Schinkel AF, Boersma E, Boccanelli A et al.| title=Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: relation to viability and improvement in left ventricular ejection fraction. | journal=Heart | year= 2009 | volume= 95 | issue= 15 | pages= 1273-7 | pmid=19443475 | doi=10.1136/hrt.2008.163972 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19443475 }} </ref><ref name="pmid10362184">{{cite journal| author=Senior R, Kaul S, Lahiri A| title=Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure. | journal=J Am Coll Cardiol | year= 1999 | volume= 33 | issue= 7 | pages= 1848-54 | pmid=10362184 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10362184 }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''8.''' Magnetic resonance imaging is reasonable when assessing myocardial infiltrative processes or scar burden.<ref name="pmid19356530">{{cite journal| author=Kwon DH, Halley CM, Carrigan TP, Zysek V, Popovic ZB, Setser R et al.| title=Extent of left ventricular scar predicts outcomes in ischemic cardiomyopathy patients with significantly reduced systolic function: a delayed hyperenhancement cardiac magnetic resonance study. | journal=JACC Cardiovasc Imaging | year= 2009 | volume= 2 | issue= 1 | pages= 34-44 | pmid=19356530 | doi=10.1016/j.jcmg.2008.09.010 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19356530 }} </ref><ref name="pmid20159642">{{cite journal| author=Syed IS, Glockner JF, Feng D, Araoz PA, Martinez MW, Edwards WD et al.| title=Role of cardiac magnetic resonance imaging in the detection of cardiac amyloidosis. | journal=JACC Cardiovasc Imaging | year= 2010 | volume= 3 | issue= 2 | pages= 155-64 | pmid=20159642 | doi=10.1016/j.jcmg.2009.09.023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20159642 }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: ]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''9.''' Invasive hemodynamic monitoring can be useful for carefully selected patients with acute HF who have persistent symptoms despite empiric adjustment of standard therapies and<br>
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| a. whose fluid status, perfusion, or systemic or pulmonary vascular resistance is uncertain;
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| b. whose systolic pressure remains low, or is associated with symptoms, despite initial therapy;
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| c. whose renal function is worsening with therapy;
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| d. who require parenteral vasoactive agents; or
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| e. who may need consideration for MCS or transplantation.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''10.''' When ischemia may be contributing to HF, coronary arteriography is reasonable for patients eligible for revascularization.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''11.''' Endomyocardial biopsy can be useful in patients presenting with HF when a specific diagnosis is suspected that would influence therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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| | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
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| |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The usefulness of serial measurement of [[B-type natriuretic peptide|BNP]] or [[B-type natriuretic peptide|N-terminal pro-B-type natriuretic peptide (NT-proBNP)]] to reduce hospitalization or mortality in patients with [[HF]] is not well established.<ref name="pmid22018299">{{cite journal| author=Januzzi JL, Rehman SU, Mohammed AA, Bhardwaj A, Barajas L, Barajas J et al.| title=Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 18 | pages= 1881-9 | pmid=22018299 | doi=10.1016/j.jacc.2011.03.072 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22018299 }} </ref><ref name="pmid20117364">{{cite journal| author=Lainchbury JG, Troughton RW, Strangman KM, Frampton CM, Pilbrow A, Yandle TG et al.| title=N-terminal pro-B-type natriuretic peptide-guided treatment for chronic heart failure: results from the BATTLESCARRED (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) trial. |journal=J Am Coll Cardiol | year= 2009 | volume= 55 | issue= 1 | pages= 53-60 | pmid=20117364 | doi=10.1016/j.jacc.2009.02.095 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20117364 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404373 Review in: Ann Intern Med. 2010 Apr 20;152(8):JC4-4] </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'', Measurement of other clinically available tests such as biomarkers of myocardial injury or fibrosis may be considered for additive risk stratification in patients with chronic [[HF]]. <ref name="pmid12912820">{{cite journal| author=Horwich TB, Patel J, MacLellan WR, Fonarow GC| title=Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. | journal=Circulation | year= 2003 | volume= 108 | issue= 7 | pages= 833-8 | pmid=12912820 | doi=10.1161/01.CIR.0000084543.79097.34 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12912820 }} </ref><ref name="pmid20130888">{{cite journal| author=Lok DJ, Van Der Meer P, de la Porte PW, Lipsic E, Van Wijngaarden J, Hillege HL et al.| title=Prognostic value of galectin-3, a novel marker of fibrosis, in patients with chronic heart failure: data from the DEAL-HF study. | journal=Clin Res Cardiol | year= 2010 | volume= 99 | issue= 5 | pages= 323-8 | pmid=20130888 | doi=10.1007/s00392-010-0125-y | pmc=PMC2858799 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20130888 }} </ref>([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| ==Vote on and Suggest Revisions to the Current Guidelines==
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| *[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
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| ==External Links==
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| *[http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8807.full.pdf 2013 ACCF/AHA Guideline for the Management of Heart Failure]<ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= | issue= | pages= | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642 }} </ref>
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| *[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>
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| *[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="pmid16160202">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16160202 ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.] ''Circulation'' 112 (12):e154-235. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI:10.1161/CIRCULATIONAHA.105.167586]PMID: [http://pubmed.gov/16160202 16160202]</ref>
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| ==References==
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| {{Reflist|2}}
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