guidelineQandA.jsonl

{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the guideline document for Chronic Coronary Disease ? [/INST] 2023AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease.2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease” provides an update to and consolidates new evidence since the “2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease” and the corresponding “2014 ACC/AHA/AATS/PCNA/SCAI/STS\nFocused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the TAKE-HOME MESSAGES FOR CHRONIC\nCORONARY DISEASE [/INST] 1. Emphasis is on team-based, patient-centered care that\nconsiders social determinants of health along with\nassociated costs while incorporating shared decisionmaking in risk assessment, testing, and treatment.\n2. Nonpharmacologic therapies, including healthy dietary habits and exercise, are recommended for all\npatients with chronic coronary disease (CCD).\n3. Patients with CCD who are free from contraindications\nare encouraged to participate in habitual physical activity, including activities to reduce sitting time and\nto increase aerobic and resistance exercise.\nCardiac rehabilitation for eligible patients provides\nsignificant cardiovascular benefits, including\ndecreased morbidity and mortality outcomes.\n4. Use of sodium glucose cotransporter 2 inhibitors and\nglucagon-like peptide-1 receptor agonists are recommended for select groups of patients with CCD,\nincluding groups without diabetes.\n5. New recommendations for beta-blocker use in patients with CCD: (a) Long-term beta-blocker therapy is\nnot recommended to improve outcomes in patients\nwith CCD in the absence of myocardial infarction in\nthe past year, left ventricular ejection fraction #50%,\nor another primary indication for beta-blocker therapy; and (b) Either a calcium channel blocker or beta\nblocker is recommended as first-line antianginal\ntherapy.\n6. Statins remain first line therapy for lipid lowering in\npatients with CCD. Several adjunctive therapies (eg,\nezetimibe, PCSK9 [proprotein convertase subtilisin/\nkexin type 9] inhibitors, inclisiran, bempedoic acid)\nmay be used in select populations, although clinical\noutcomes data are unavailable for novel agents such\nas inclisiran.\n7. Shorter durations of dual antiplatelet therapy are safe\nand effective in many circumstances, particularly\nwhen the risk of bleeding is high and the ischemic risk\nis low to moderate.\n8. The use of nonprescription or dietary supplements,\nincluding fish oil and omega-3 fatty acids or vitamins,\nis not recommended in patients with CCD given the\nlack of benefit in reducing cardiovascular events.\n9. Routine periodic anatomic or ischemic testing without\na change in clinical or functional status is not recommended for risk stratification or to guide therapeutic\ndecision-making in patients with CCD.\n10. Although e-cigarettes increase the likelihood of successful smoking cessation compared with nicotine\nreplacement therapy, because of the lack of long-term\nsafety data and risks of sustained use, e-cigarettes are\nnot recommended as first-line therapy for smoking\ncessation. </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the guidelines for the Diagnosis and Management of\nAortic Disease ? [/INST] The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and longterm surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHLComplete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate.Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an\nincreased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the Guideline for the Management of Heart Failure? [/INST] AIM The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” replaces the “2013 ACCF/AHA Guideline for the\nManagement of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management\nof Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and\nmanage patients with heart failure.\nMETHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews,\nand other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane\nCollaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and\nresearch studies, published through September 2021, were also considered. This guideline was harmonized with other American\nHeart Association/American College of Cardiology guidelines published through December 2021.\nSTRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides\nrecommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidencebased approach to managing patients with heart failure, with the intent to improve quality of care and align with patients’ interests.\nMany recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations\nhave been created when suppor </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the take away of document 2022 AHA/ACC/HFSA Guideline for\nthe Management of Heart Failure ? [/INST] 1. Guideline-directed medical therapy (GDMT) for heart\nfailure (HF) with reduced ejection fraction (HFrEF)\nnow includes 4 medication classes that\ninclude sodium-glucose cotransporter-2 inhibitors\n(SGLT2i).\n2. SGLT2i have a Class of Recommendation 2a in HF with\nmildly reduced ejection fraction (HFmrEF). Weaker\nrecommendations (Class of Recommendation 2b)\nare made for ARNi, ACEi, ARB, MRA, and beta blockers\nin this population.\n3. New recommendations for HFpEF are made for\nSGLT2i (Class of Recommendation 2a), MRAs (Class of\nRecommendation 2b), and ARNi (Class of Recommendation 2b). Several prior recommendations have\nbeen renewed including treatment of hypertension\n(Class of Recommendation 1), treatment of atrial\nfibrillation (Class of Recommendation 2a), use of ARBs\n(Class of Recommendation 2b), and avoidance of\nroutine use of nitrates or phosphodiesterase-5 inhibitors (Class of Recommendation 3: No Benefit).\n4. Improved LVEF is used to refer to those patients with\nprevious HFrEF who now have an LVEF >40%. These\npatients should continue their HFrEF treatment.\n5. Value statements were created for select recommendations where high-quality, cost-effectiveness studies\nof the intervention have been published.\n6. Amyloid heart disease has new recommendations\nfor treatment including screening for serum and\nurine monoclonal light chains, bone scintigraphy,\ngenetic sequencing, tetramer stabilizer therapy, and\nanticoagulation.\n7. Evidence supporting increased filling pressures is\nimportant for the diagnosis of HF if the LVEF is >40%.\nEvidence for increased filling pressures can be obtained from noninvasive (e.g., natriuretic peptide,\ndiastolic function on imaging) or invasive testing\n(e.g., hemodynamic measurement).\n8. Patients with advanced HF who wish to prolong survival should be referred to a team specializing in HF. A\nHF specialty team reviews HF management, assesses\nsuitability for advanced HF therapies, and uses palliative care including palliative inotropes where consistent with the patient’s goals of care.\n9. Primary prevention is important for those at risk for\nHF (stage A) or pre-HF (stage B). Stages of HF were\nrevised to emphasize the new terminologies of “at\nrisk” for HF for stage A and pre-HF for stage B.\n10. Recommendations are provided for select patients\nwith HF and iron deficiency, anemia, hypertension,\nsleep disorders, type 2 diabetes, atrial fibrillation,\ncoronary artery disease, and malignancy. </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>Whar are the Guideline for the Diagnosis and Treatment of Patients\nWith Hypertrophic Cardiomyopathy ? [/INST] 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients\nWith Hypertrophic Cardiomyopathy A Report of the American College of Cardiology/American Heart Association Joint Committee on\nClinical Practice Guidelines Developed in collaboration with and endorsed by the American Association for Thoracic Surgery,\nAmerican Society of Echocardiography, Heart Failure Society of America, Heart Rhythm Society, Society\nfor Cardiovascular Angiography and Interventions, and Society for Cardiovascular Magnetic Resonance.\nEndorsed by The Pediatric & Congenital Electrophysiology Society </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What aret the TOP 10 TAKE-HOME MESSAGES - 2020 AHA/ACC .GUIDELINE FOR THE DIAGNOSIS AND TREATMENT\nOF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY? [/INST] 1. Shared decision-making, a dialogue between patients\nand their care team that includes full disclosure of all\ntesting and treatment options, discussion of the risks\nand benefits of those options and, importantly,\nengagement of the patient to express their own goals,\nis particularly relevant in the management of conditions such as hypertrophic cardiomyopathy (HCM).\n2. Although the primary cardiology team can initiate\nevaluation, treatment, and longitudinal care, referral\nto multidisciplinary HCM centers with graduated\nlevels of expertise can be important to optimizing care\nfor patients with HCM. Challenging treatment decisions—where reasonable alternatives exist, where\nthe strength of recommendation is weak (e.g., any\nClass 2b decision) or is particularly nuanced, and for\ninvasive procedures that are specific to patients with\nHCM—represent crucial opportunities to refer patients\nto these HCM centers.\n3. Counseling patients with HCM regarding the potential\nfor genetic transmission of HCM is one of the cornerstones of care. Screening first-degree family members\nof patients with HCM, using either genetic testing or\nan imaging/electrocardiographic surveillance protocol, can begin at any age and can be influenced by\nspecifics of the patient/family history and family\npreference. As screening recommendations for family\nmembers hinge on the pathogenicity of any detected\nvariants, the reported pathogenicity should be\nreconfirmed every 2 to 3 years.\n4. Optimal care for patients with HCM requires cardiac\nimaging to confirm the diagnosis, characterize the\npathophysiology for the individual, and identify risk\nmarkers that may inform decisions regarding interventions for left ventricular outflow tract obstruction and sudden cardiac death (SCD) prevention.\nEchocardiography continues to be the foundational\nimaging modality for patients with HCM. Cardiovascular magnetic resonance imaging will also be helpful\nin many patients, especially those in whom there is\ndiagnostic uncertainty, poor echocardiographic imaging windows, or where uncertainty persists\nregarding decisions around implantable cardioverterdefibrillator (ICD) placement.\n5. Assessment of an individual patient’s risk for SCD\ncontinues to evolve as new markers emerge (e.g.,\napical aneurysm, decreased left ventricular systolic\nfunction, and extensive gadolinium enhancement). In\naddition to a full accounting of an individual’s risk\nmarkers, communication with patients regarding not\njust the presence of risk markers but also the magnitude of their individualized risk is key. This enables\nthe informed patient to fully participate in the\ndecision-making regarding ICD placement, which incorporates their own level of risk tolerance and\ntreatment goals.\n6. The risk factors for SCD in children with HCM carry\ndifferent weights than those observed in adult patients; they vary with age and must account for\nJACC VOL. 76, NO. 25, 2020 Ommen et al.\nDECEMBER 22, 2020:e159 – 240 2020 AHA/ACC HCM Guideline\ne161\ndifferent body sizes. Coupled with the complexity of\nplacing ICDs in young patients with anticipated\ngrowth and a higher risk of device complications, the\nthreshold for ICD implantation in children often differs from adults. These differences are best addressed\nat primary or comprehensive HCM centers with\nexpertise in children with HCM.\n7. Septal reduction therapies (surgical septal myectomy\nand alcohol septal ablation), when performed by\nexperienced HCM teams at dedicated centers,\ncontinue to improve in safety and efficacy such that\nearlier intervention may be possible in select patients\nwith drug-refractory or severe outflow tract obstruction causing signs of cardiac decompensation. Given\nthe data on the significantly improved outcomes at\ncomprehensive HCM centers, these decisions represent an optimal referral opportunity.\n8. Patients with HCM and persistent or paroxysmal atrial\nfibrillation have a sufficiently increased risk of stroke\nsuch that oral anticoagulation with direct oral anticoagulants (or alternatively warfarin) should be\nconsidered the default treatment option independent\nof the CHA2DS2VASc score. As rapid atrial fibrillation\nis often poorly tolerated in patients with HCM,\nmaintenance of sinus rhythm and rate control are key\npursuits in successful treatment.\n9. Heart failure symptoms in patients with HCM, in the\nabsence of left ventricular outflow tract obstruction,\nshould be treated similarly to other patients with\nheart failure symptoms, including consideration of\nadvanced treatment options (e.g., cardiac resynchronization therapy, left ventricular assist device, transplantation). In patients with HCM, an ejection\nfraction <50% connotes significantly impaired systolic function and identifies individuals with poor\nprognosis and who are at increased risk for SCD.\n10. Increasingly, data affirm that the beneficial effects of\nexercise on general health can be extended to patients\nwith HCM. Healthy recreational exercise (moderate\nintensity) has not been associated with increased risk\nof ventricular arrhythmia events in recent studies.\nWhether an individual patient with HCM wishes to\npursue more rigorous exercise/training is dependent\non a comprehensive shared discussion between that\npatient and their expert HCM care team regarding the\npotential risks of that level of training/participation\nbut with the understanding that exercise-related risk\ncannot be individualized for a given patient. </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the guideline document for Cardiovascular Disease ? [/INST] 2019 ACC/AHA Guideline on the\nPrimary Prevention of\nCardiovascular Disease\nA Report of the American College of Cardiolog </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the TOP 10 TAKE-HOME MESSAGES FOR THE PRIMARY\nPREVENTION OF CARDIOVASCULAR DISEASE? [/INST] TOP 10 TAKE-HOME MESSAGES FOR THE PRIMARY\nPREVENTION OF CARDIOVASCULAR DISEASE\n1. The most important way to prevent atherosclerotic\nvascular disease, heart failure, and atrial fibrillation is\nto promote a healthy lifestyle throughout life.\n2. A team-based care approach is an effective strategy\nfor the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of\nhealth that affect individuals to inform treatment\ndecisions.\nArnett et al. JACC VOL. 74, NO. 10, 2019\n2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease SEPTEMBER 10, 2019:e177 – 232\ne178\n3. Adults who are 40 to 75 years of age and are being\nevaluated for cardiovascular disease prevention should\nundergo 10-year atherosclerotic cardiovascular disease\n(ASCVD) risk estimation and have a clinician–patient\nrisk discussion before starting on pharmacological\ntherapy, such as antihypertensive therapy, a statin, or\naspirin. In addition, assessing for other risk-enhancing\nfactors can help guide decisions about preventive interventions in select individuals, as can coronary artery\ncalcium scanning.\n4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole\ngrains, lean vegetable or animal protein, and fish and\nminimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages. For adults with overweight and\nobesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.\n5. Adults should engage in at least 150 minutes per week\nof accumulated moderate-intensity physical activity\nor 75 minutes per week of vigorous-intensity physical\nactivity.\n6. For adults with type 2 diabetes mellitus, lifestyle\nchanges, such as improving dietary habits and\nachieving exercise recommendations, are crucial. If\nmedication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose\ncotransporter 2 inhibitor or a glucagon-like peptide-1\nreceptor agonist.\n7. All adults should be assessed at every healthcare visit\nfor tobacco use, and those who use tobacco should be\nassisted and strongly advised to quit.\n8. Aspirin should be used infrequently in the routine\nprimary prevention of ASCVD because of lack of net\nbenefit.\n9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated lowdensity lipoprotein cholesterol levels ($190 mg/dL),\nthose with diabetes mellitus, who are 40 to 75 years of\nage, and those determined to be at sufficient ASCVD\nrisk after a clinician–patient risk discussion.\n10. Nonpharmacological interventions are recommended\nfor all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy,\nthe target blood pressure should generally be <130/80\nmm Hg. </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the Guideline on the Management of Blood Cholesterol ? [/INST] 2018 AHA/ACC/AACVPR/AAPA/\nABC/ACPM/ADA/AGS/APhA/ASPC/\nNLA/PCNA Guideline on the\nManagement of Blood Cholesterol\nA Report of the American College of Cardiology/American Heart Association\nTask Force on Clinical Practice Guidelines </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What aret the TOP 10 TAKE-HOME MESSAGES TO REDUCE RISK\nOF ATHEROSCLEROTIC CARDIOVASCULAR? [/INST] \n1. In all individuals, emphasize a heart-healthy lifestyle\nacross the life course. A healthy lifestyle reduces\natherosclerotic cardiovascular disease (ASCVD) risk at\nall ages. In younger individuals, healthy lifestyle can\nreduce development of risk factors and is the foundation of ASCVD risk reduction. In young adults 20 to\n39 years of age, an assessment of lifetime risk facilitates the clinician–patient risk discussion (see No. 6)\nand emphasizes intensive lifestyle efforts. In all age\ngroups, lifestyle therapy is the primary intervention\nfor metabolic syndrome.\n2. In patients with clinical ASCVD, reduce low-density\nlipoprotein cholesterol (LDL-C) with high-intensity\nstatin therapy or maximally tolerated statin therapy. The more LDL-C is reduced on statin therapy, the\ngreater will be subsequent risk reduction. Use a\nmaximally tolerated statin to lower LDL-C levels\nby $50%.\n3. In very high-risk ASCVD, use a LDL-C threshold of 70\nmg/dL (1.8 mmol/L) to consider addition of nonstatins to statin therapy. Very high-risk includes a\nhistory of multiple major ASCVD events or 1 major\nASCVD event and multiple high-risk conditions. In\nvery high-risk ASCVD patients, it is reasonable to add\nezetimibe to maximally tolerated statin therapy when\nthe LDL-C level remains $70 mg/dL ($1.8 mmol/L). In\npatients at very high risk whose LDL-C level\nremains $70 mg/dL ($1.8 mmol/L) on maximally\ntolerated statin and ezetimibe therapy, adding a\nPCSK9 inhibitor is reasonable, although the long-term\nsafety (>3 years) is uncertain and cost effectiveness is\nlow at mid-2018 list prices.\n4. In patients with severe primary hypercholesterolemia (LDL-C level ‡190 mg/dL [‡4.9 mmol/L]),\nwithout calculating 10-year ASCVD risk, begin highintensity statin therapy. If the LDL-C level\nremains $100 mg/dL ($2.6 mmol/L), adding ezetimibe is reasonable. If the LDL-C level on statin plus\nezetimibe remains $100 mg/dL ($2.6 mmol/L) and\nthe patient has multiple factors that increase subsequent risk of ASCVD events, a PCSK9 inhibitor\nmay be considered, although the long-term safety\n(>3 years) is uncertain and economic value is\nuncertain at mid-2018 list prices.\n5. In patients 40 to 75 years of age with diabetes mellitus and LDL-C ‡70 mg/dL (‡1.8 mmol/L), start\nmoderate-intensity statin therapy without calculating 10-year ASCVD risk. In patients with diabetes\nmellitus at higher risk, especially those with multiple\nrisk factors or those 50 to 75 years of age, it is\nreasonable to use a high-intensity statin to reduce the\nLDL-C level by $50%.\n6. In adults 40 to 75 years of age evaluated for primary\nASCVD prevention, have a clinician–patient risk discussion before starting statin therapy. Risk discussion should include a review of major risk factors\n(e.g., cigarette smoking, elevated blood pressure,\nLDL-C, hemoglobin A1C [if indicated], and calculated\n10-year risk of ASCVD); the presence of risk-enhancing\nfactors (see No. 8); the potential benefits of lifestyle\nand statin therapies; the potential for adverse effects\nand drug–drug interactions; consideration of costs of\nstatin therapy; and patient preferences and values in\nshared decision-making.\n7. In adults 40 to 75 years of age without diabetes\nmellitus and with LDL-C levels ‡70 mg/dL (‡1.8\nmmol/L), at a 10-year ASCVD risk of $7.5%, start a\nmoderate-intensity statin if a discussion of treatment\noptions favors statin therapy. Risk-enhancing factors\nfavor statin therapy (see No. 8). If risk status is uncertain, consider using coronary artery calcium (CAC)\nto improve specificity (see No. 9). If statins are\nJACC VOL. 73, NO. 24, 2019 Grundy et al.\nJUNE 25, 2019:e285-350 2018 Cholesterol Clinical Practice Guideline\ne287\nindicated, reduce LDL-C levels by $30%, and if 10-\nyear risk is $20%, reduce LDL-C levels by $50%.\n8. In adults 40 to 75 years of age without\ndiabetes mellitus and 10-year risk of 7.5% to 19.9%\n(intermediate risk), risk-enhancing factors favor\ninitiation of statin therapy (see No. 7). Riskenhancing factors include family history of premature ASCVD; persistently elevated LDL-C levels\n$160 mg/dL ($4.1 mmol/L); metabolic syndrome;\nchronic kidney disease; history of preeclampsia or\npremature menopause (age <40 years); chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, or chronic HIV); high-risk ethnic groups (e.g.,\nSouth Asian); persistent elevations of triglycerides\n$175 mg/dL ($1.97 mmol/L); and, if measured in\nselected individuals, apolipoprotein B $130 mg/dL, highsensitivity C-reactive protein $2.0 mg/L, ankle-brachial\nindex <0.9 and lipoprotein (a) $50 mg/dL or 125 nmol/L,\nespecially at higher values of lipoprotein (a).\nRisk-enhancing factors may favor statin therapy\nin patients at 10-year risk of 5-7.5% (borderline risk).\n9. In adults 40 to 75 years of age without diabetes\nmellitus and with LDL-C levels ‡70 mg/dL- 189 mg/dL\n(‡1.8-4.9 mmol/L), at a 10-year ASCVD risk of ‡7.5%\nto 19.9%, if a decision about statin therapy is uncertain, consider measuring CAC. If CAC is zero, treatment with statin therapy may be withheld or delayed,\nexcept in cigarette smokers, those with diabetes\nmellitus, and those with a strong family history of\npremature ASCVD. A CAC score of 1 to 99 favors statin\ntherapy, especially in those $55 years of age. For any\npatient, if the CAC score is $100 Agatston units\nor $75th percentile, statin therapy is indicated unless\notherwise deferred by the outcome of clinician–\npatient risk discussion.\n10. Assess adherence and percentage response to LDL-C–\nlowering medications and lifestyle changes with\nrepeat lipid measurement 4 to 12 weeks after statin\ninitiation or dose adjustment, repeated every 3 to 12\nmonths as needed. Define responses to lifestyle and\nstatin therapy by percentage reductions in LDL-C\nlevels compared with baseline. In ASCVD patients at\nvery high-risk, triggers for adding nonstatin drug\ntherapy are defined by threshold LDL-C levels $70\nmg/dL ($1.8 mmol/L) on maximal statin therapy   </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the Guideline on\nthe Evaluation and Management\nof Patients With Bradycardia and\nCardiac Conduction Delay? [/INST] 2018 ACC/AHA/HRS Guideline on\nthe Evaluation and Management\nof Patients With Bradycardia and\nCardiac Conduction Delay\nA Report of the American College of Cardiology/American Heart Association Task Force on\nClinical Practice Guidelines and the Heart Rhythm Society </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the TOP 10 TAKE-HOME MESSAGES FOR THE\nMANAGEMENT OF BRADYCARDIA AND\nCARDIAC CONDUCTION DELAY? [/INST] \n1. Sinus node dysfunction is most often related to agedependent progressive fibrosis of the sinus nodal tissue and surrounding atrial myocardium leading to\nabnormalities of sinus node and atrial impulse formation and propagation and will therefore result in\nvarious bradycardic or pause-related syndromes.\nJACC VOL. 74, NO. 7, 2019 Kusumoto et al.\nAUGUST 20, 2019:e51 – 156 2018 Bradycardia Guideline\ne53\n2. Both sleep disorders of breathing and nocturnal bradycardias are relatively common, and treatment of\nsleep apnea not only reduces the frequency of these\narrhythmias but also may offer cardiovascular benefits. The presence of nocturnal bradycardias should\nprompt consideration for screening for sleep apnea,\nbeginning with solicitation of suspicious symptoms.\nHowever, nocturnal bradycardia is not in itself an\nindication for permanent pacing.\n3. The presence of left bundle branch block on electrocardiogram markedly increases the likelihood of underlying structural heart disease and of diagnosing\nleft ventricular systolic dysfunction. Echocardiography is usually the most appropriate initial screening\ntest for structural heart disease, including left ventricular systolic dysfunction.\n4. In sinus node dysfunction, there is no established\nminimum heart rate or pause duration where permanent pacing is recommended. Establishing temporal\ncorrelation between symptoms and bradycardia is\nimportant when determining whether permanent\npacing is needed.\n5. In patients with acquired second-degree Mobitz type\nII atrioventricular block, high-grade atrioventricular\nblock, or third-degree atrioventricular block not\ncaused by reversible or physiologic causes, permanent\npacing is recommended regardless of symptoms. For\nall other types of atrioventricular block, in the\nabsence of conditions associated with progressive\natrioventricular conduction abnormalities, permanent\npacing should generally be considered only in the\npresence of symptoms that correlate with atrioventricular block.\n6. In patients with a left ventricular ejection fraction\nbetween 36% to 50% and atrioventricular block, who\nhave an indication for permanent pacing and are expected to require ventricular pacing >40% of the time,\ntechniques that provide more physiologic ventricular\nactivation (e.g., cardiac resynchronization therapy,\nHis bundle pacing) are preferred to right ventricular\npacing to prevent heart failure.\n7. Because conduction system abnormalities are common after transcatheter aortic valve replacement,\nrecommendations on postprocedure surveillance and\npacemaker implantation are made in this guideline.\n8. In patients with bradycardia who have indications for\npacemaker implantation, shared decision-making and\npatient-centered care are endorsed and emphasized in\nthis guideline. Treatment decisions are based on the\nbest available evidence and on the patient’s goals of\ncare and preferences.\n9. Using the principles of shared decision-making and\ninformed consent/refusal, patients with decisionmaking capacity or his/her legally defined surrogate\nhas the right to refuse or request withdrawal of\npacemaker therapy, even if the patient is pacemaker\ndependent, which should be considered palliative,\nend-of-life care, and not physician-assisted suicide.\nHowever, any decision is complex, should involve all\nstakeholders, and will always be patient specific.\n10. Identifying patient populations that will benefit the\nmost from emerging pacing technologies (e.g., His\nbundle pacing, transcatheter leadless pacing systems)\nwill require further investigation as these modalities\nare incorporated into clinical practice. </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the  Guideline for the\nManagement of Adults With\nCongenital Heart Disease? [/INST] 2018 AHA/ACC Guideline for the\nManagement of Adults With\nCongenital Heart Disease\nA Report of the American College of Cardiolo </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>what are the Guideline for the Prevention,\nDetection, Evaluation, and Management\nof High Blood Pressure in Adults ? [/INST] 2017 ACC/AHA/AAPA/ABC/ACPM/\nAGS/APhA/ASH/ASPC/NMA/PCNA\nGuideline for the Prevention,\nDetection, Evaluation, and Management\nof High Blood Pressure in Adults </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the document for  Sudden Cardiac Death? [/INST] 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society </s>"}
{"text": "<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, say that you don't know. Please don't share false information. <</SYS>>What are the guideline document for Syncope? [/INST] 2017 ACC/AHA/HRS Guideline for the\nEvaluation and Management of\nPatients With Syncope\nA Report of the American College of Cardiology/American Heart Association\nTask Force on Clinical Practice Guidelines and the Heart Rhythm Society </s>"}