1ESC guidelines observe that if ablation is done in expert centers, ablation reduces recurrence rate much more than antiarrhythmics for paroxysmal AF. The long-term benefit is less certain for persistent AF.
1Major risk factors: Previous stroke, TIA, systemic embolism, age ≥75. Other relevant risk factors: HF or LVEF ≤40%, HTN, DM, female sex, age 65–74, vascular disease. (JAMA. 2001;285:2864-2870)
1Descriptors including central, pressure, squeezing, gripping, heaviness, tightness, exertional/stress-related, and retrosternal carry high probability of ischemia. Descriptors including sharp, fleeting, shifting, pleuritic, and positional are lower probability.
1TIMI Risk Score predicts 30-d and 1-y mortality in ACS (mortality rises at TIMI = 3–4). 1 point each for age ≥65, ≥3 risk factors for CAD, known CAD, ST changes on ECG (≥0.5 mm), active angina (≥2 episodes in past 24 h), aspirin in past 7 d, elevated cardiac marker.
2GRACE risk model predicts in-hospital and postdischarge mortality or MI. Downloadable tool: http://www.outcomes-umassmed.org/grace/
1Race-based recommendations for specific therapies are controversial, in part because the definition of racial groups is not standardized. This guidance comes from a study that looked at patients identified as Black with NYHA Class III or IV HF. All were given standard therapies, and the groups were randomized to add either placebo or isosorbide dinitrate + hydralazine. Mortality rate, admission rate, and quality life were significantly worse in the placebo group. (N Engl J Med. 2004; 351:2049-2057)
1Previous MI, LV remodeling/LVH and low EF, or asymptomatic valvular disease
2Known structural heart disease; shortness of breath and fatigue, reduced exercise tolerance
3Symptoms at rest despite maximal medical therapy; recurrent hospitalizations
1ACC/AHA: low risk means combined surgical and patient characteristics that predict risk of a major adverse cardiac event (MACE) of death or MI of <1%.
1Stage C1: Asymptomatic; LVEF >60% and LVEDS <40 mm, or new-onset AF or PASP > 50 mmHg.