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<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
Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. </s> |
<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
CORONARY DISEASE [/INST] 1. Emphasis is on team-based, patient-centered care that
considers social determinants of health along with
associated costs while incorporating shared decisionmaking in risk assessment, testing, and treatment.
2. Nonpharmacologic therapies, including healthy dietary habits and exercise, are recommended for all
patients with chronic coronary disease (CCD).
3. Patients with CCD who are free from contraindications
are encouraged to participate in habitual physical activity, including activities to reduce sitting time and
to increase aerobic and resistance exercise.
Cardiac rehabilitation for eligible patients provides
significant cardiovascular benefits, including
decreased morbidity and mortality outcomes.
4. Use of sodium glucose cotransporter 2 inhibitors and
glucagon-like peptide-1 receptor agonists are recommended for select groups of patients with CCD,
including groups without diabetes.
5. New recommendations for beta-blocker use in patients with CCD: (a) Long-term beta-blocker therapy is
not recommended to improve outcomes in patients
with CCD in the absence of myocardial infarction in
the past year, left ventricular ejection fraction #50%,
or another primary indication for beta-blocker therapy; and (b) Either a calcium channel blocker or beta
blocker is recommended as first-line antianginal
therapy.
6. Statins remain first line therapy for lipid lowering in
patients with CCD. Several adjunctive therapies (eg,
ezetimibe, PCSK9 [proprotein convertase subtilisin/
kexin type 9] inhibitors, inclisiran, bempedoic acid)
may be used in select populations, although clinical
outcomes data are unavailable for novel agents such
as inclisiran.
7. Shorter durations of dual antiplatelet therapy are safe
and effective in many circumstances, particularly
when the risk of bleeding is high and the ischemic risk
is low to moderate.
8. The use of nonprescription or dietary supplements,
including fish oil and omega-3 fatty acids or vitamins,
is not recommended in patients with CCD given the
lack of benefit in reducing cardiovascular events.
9. Routine periodic anatomic or ischemic testing without
a change in clinical or functional status is not recommended for risk stratification or to guide therapeutic
decision-making in patients with CCD.
10. Although e-cigarettes increase the likelihood of successful smoking cessation compared with nicotine
replacement therapy, because of the lack of long-term
safety data and risks of sustained use, e-cigarettes are
not recommended as first-line therapy for smoking
cessation. </s> |
<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
Aortic 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
increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease </s> |
<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
Management of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management
of Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and
manage patients with heart failure.
METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews,
and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane
Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and
research studies, published through September 2021, were also considered. This guideline was harmonized with other American
Heart Association/American College of Cardiology guidelines published through December 2021.
STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides
recommendations 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.
Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations
have been created when suppor </s> |
<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
the Management of Heart Failure ? [/INST] 1. Guideline-directed medical therapy (GDMT) for heart
failure (HF) with reduced ejection fraction (HFrEF)
now includes 4 medication classes that
include sodium-glucose cotransporter-2 inhibitors
(SGLT2i).
2. SGLT2i have a Class of Recommendation 2a in HF with
mildly reduced ejection fraction (HFmrEF). Weaker
recommendations (Class of Recommendation 2b)
are made for ARNi, ACEi, ARB, MRA, and beta blockers
in this population.
3. New recommendations for HFpEF are made for
SGLT2i (Class of Recommendation 2a), MRAs (Class of
Recommendation 2b), and ARNi (Class of Recommendation 2b). Several prior recommendations have
been renewed including treatment of hypertension
(Class of Recommendation 1), treatment of atrial
fibrillation (Class of Recommendation 2a), use of ARBs
(Class of Recommendation 2b), and avoidance of
routine use of nitrates or phosphodiesterase-5 inhibitors (Class of Recommendation 3: No Benefit).
4. Improved LVEF is used to refer to those patients with
previous HFrEF who now have an LVEF >40%. These
patients should continue their HFrEF treatment.
5. Value statements were created for select recommendations where high-quality, cost-effectiveness studies
of the intervention have been published.
6. Amyloid heart disease has new recommendations
for treatment including screening for serum and
urine monoclonal light chains, bone scintigraphy,
genetic sequencing, tetramer stabilizer therapy, and
anticoagulation.
7. Evidence supporting increased filling pressures is
important for the diagnosis of HF if the LVEF is >40%.
Evidence for increased filling pressures can be obtained from noninvasive (e.g., natriuretic peptide,
diastolic function on imaging) or invasive testing
(e.g., hemodynamic measurement).
8. Patients with advanced HF who wish to prolong survival should be referred to a team specializing in HF. A
HF specialty team reviews HF management, assesses
suitability for advanced HF therapies, and uses palliative care including palliative inotropes where consistent with the patient’s goals of care.
9. Primary prevention is important for those at risk for
HF (stage A) or pre-HF (stage B). Stages of HF were
revised to emphasize the new terminologies of “at
risk” for HF for stage A and pre-HF for stage B.
10. Recommendations are provided for select patients
with HF and iron deficiency, anemia, hypertension,
sleep disorders, type 2 diabetes, atrial fibrillation,
coronary artery disease, and malignancy. </s> |
<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
With Hypertrophic Cardiomyopathy ? [/INST] 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients
With Hypertrophic Cardiomyopathy A Report of the American College of Cardiology/American Heart Association Joint Committee on
Clinical Practice Guidelines Developed in collaboration with and endorsed by the American Association for Thoracic Surgery,
American Society of Echocardiography, Heart Failure Society of America, Heart Rhythm Society, Society
for Cardiovascular Angiography and Interventions, and Society for Cardiovascular Magnetic Resonance.
Endorsed by The Pediatric & Congenital Electrophysiology Society </s> |
<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
OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY? [/INST] 1. Shared decision-making, a dialogue between patients
and their care team that includes full disclosure of all
testing and treatment options, discussion of the risks
and benefits of those options and, importantly,
engagement of the patient to express their own goals,
is particularly relevant in the management of conditions such as hypertrophic cardiomyopathy (HCM).
2. Although the primary cardiology team can initiate
evaluation, treatment, and longitudinal care, referral
to multidisciplinary HCM centers with graduated
levels of expertise can be important to optimizing care
for patients with HCM. Challenging treatment decisions—where reasonable alternatives exist, where
the strength of recommendation is weak (e.g., any
Class 2b decision) or is particularly nuanced, and for
invasive procedures that are specific to patients with
HCM—represent crucial opportunities to refer patients
to these HCM centers.
3. Counseling patients with HCM regarding the potential
for genetic transmission of HCM is one of the cornerstones of care. Screening first-degree family members
of patients with HCM, using either genetic testing or
an imaging/electrocardiographic surveillance protocol, can begin at any age and can be influenced by
specifics of the patient/family history and family
preference. As screening recommendations for family
members hinge on the pathogenicity of any detected
variants, the reported pathogenicity should be
reconfirmed every 2 to 3 years.
4. Optimal care for patients with HCM requires cardiac
imaging to confirm the diagnosis, characterize the
pathophysiology for the individual, and identify risk
markers that may inform decisions regarding interventions for left ventricular outflow tract obstruction and sudden cardiac death (SCD) prevention.
Echocardiography continues to be the foundational
imaging modality for patients with HCM. Cardiovascular magnetic resonance imaging will also be helpful
in many patients, especially those in whom there is
diagnostic uncertainty, poor echocardiographic imaging windows, or where uncertainty persists
regarding decisions around implantable cardioverterdefibrillator (ICD) placement.
5. Assessment of an individual patient’s risk for SCD
continues to evolve as new markers emerge (e.g.,
apical aneurysm, decreased left ventricular systolic
function, and extensive gadolinium enhancement). In
addition to a full accounting of an individual’s risk
markers, communication with patients regarding not
just the presence of risk markers but also the magnitude of their individualized risk is key. This enables
the informed patient to fully participate in the
decision-making regarding ICD placement, which incorporates their own level of risk tolerance and
treatment goals.
6. The risk factors for SCD in children with HCM carry
different weights than those observed in adult patients; they vary with age and must account for
JACC VOL. 76, NO. 25, 2020 Ommen et al.
DECEMBER 22, 2020:e159 – 240 2020 AHA/ACC HCM Guideline
e161
different body sizes. Coupled with the complexity of
placing ICDs in young patients with anticipated
growth and a higher risk of device complications, the
threshold for ICD implantation in children often differs from adults. These differences are best addressed
at primary or comprehensive HCM centers with
expertise in children with HCM.
7. Septal reduction therapies (surgical septal myectomy
and alcohol septal ablation), when performed by
experienced HCM teams at dedicated centers,
continue to improve in safety and efficacy such that
earlier intervention may be possible in select patients
with drug-refractory or severe outflow tract obstruction causing signs of cardiac decompensation. Given
the data on the significantly improved outcomes at
comprehensive HCM centers, these decisions represent an optimal referral opportunity.
8. Patients with HCM and persistent or paroxysmal atrial
fibrillation have a sufficiently increased risk of stroke
such that oral anticoagulation with direct oral anticoagulants (or alternatively warfarin) should be
considered the default treatment option independent
of the CHA2DS2VASc score. As rapid atrial fibrillation
is often poorly tolerated in patients with HCM,
maintenance of sinus rhythm and rate control are key
pursuits in successful treatment.
9. Heart failure symptoms in patients with HCM, in the
absence of left ventricular outflow tract obstruction,
should be treated similarly to other patients with
heart failure symptoms, including consideration of
advanced treatment options (e.g., cardiac resynchronization therapy, left ventricular assist device, transplantation). In patients with HCM, an ejection
fraction <50% connotes significantly impaired systolic function and identifies individuals with poor
prognosis and who are at increased risk for SCD.
10. Increasingly, data affirm that the beneficial effects of
exercise on general health can be extended to patients
with HCM. Healthy recreational exercise (moderate
intensity) has not been associated with increased risk
of ventricular arrhythmia events in recent studies.
Whether an individual patient with HCM wishes to
pursue more rigorous exercise/training is dependent
on a comprehensive shared discussion between that
patient and their expert HCM care team regarding the
potential risks of that level of training/participation
but with the understanding that exercise-related risk
cannot be individualized for a given patient. </s> |
<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
Primary Prevention of
Cardiovascular Disease
A Report of the American College of Cardiolog </s> |
<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
PREVENTION OF CARDIOVASCULAR DISEASE? [/INST] TOP 10 TAKE-HOME MESSAGES FOR THE PRIMARY
PREVENTION OF CARDIOVASCULAR DISEASE
1. The most important way to prevent atherosclerotic
vascular disease, heart failure, and atrial fibrillation is
to promote a healthy lifestyle throughout life.
2. A team-based care approach is an effective strategy
for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of
health that affect individuals to inform treatment
decisions.
Arnett et al. JACC VOL. 74, NO. 10, 2019
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease SEPTEMBER 10, 2019:e177 – 232
e178
3. Adults who are 40 to 75 years of age and are being
evaluated for cardiovascular disease prevention should
undergo 10-year atherosclerotic cardiovascular disease
(ASCVD) risk estimation and have a clinician–patient
risk discussion before starting on pharmacological
therapy, such as antihypertensive therapy, a statin, or
aspirin. In addition, assessing for other risk-enhancing
factors can help guide decisions about preventive interventions in select individuals, as can coronary artery
calcium scanning.
4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole
grains, lean vegetable or animal protein, and fish and
minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages. For adults with overweight and
obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.
5. Adults should engage in at least 150 minutes per week
of accumulated moderate-intensity physical activity
or 75 minutes per week of vigorous-intensity physical
activity.
6. For adults with type 2 diabetes mellitus, lifestyle
changes, such as improving dietary habits and
achieving exercise recommendations, are crucial. If
medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose
cotransporter 2 inhibitor or a glucagon-like peptide-1
receptor agonist.
7. All adults should be assessed at every healthcare visit
for tobacco use, and those who use tobacco should be
assisted and strongly advised to quit.
8. Aspirin should be used infrequently in the routine
primary prevention of ASCVD because of lack of net
benefit.
9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated lowdensity lipoprotein cholesterol levels ($190 mg/dL),
those with diabetes mellitus, who are 40 to 75 years of
age, and those determined to be at sufficient ASCVD
risk after a clinician–patient risk discussion.
10. Nonpharmacological interventions are recommended
for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy,
the target blood pressure should generally be <130/80
mm Hg. </s> |
<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/
ABC/ACPM/ADA/AGS/APhA/ASPC/
NLA/PCNA Guideline on the
Management of Blood Cholesterol
A Report of the American College of Cardiology/American Heart Association
Task Force on Clinical Practice Guidelines </s> |
<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
OF ATHEROSCLEROTIC CARDIOVASCULAR? [/INST]
1. In all individuals, emphasize a heart-healthy lifestyle
across the life course. A healthy lifestyle reduces
atherosclerotic cardiovascular disease (ASCVD) risk at
all ages. In younger individuals, healthy lifestyle can
reduce development of risk factors and is the foundation of ASCVD risk reduction. In young adults 20 to
39 years of age, an assessment of lifetime risk facilitates the clinician–patient risk discussion (see No. 6)
and emphasizes intensive lifestyle efforts. In all age
groups, lifestyle therapy is the primary intervention
for metabolic syndrome.
2. In patients with clinical ASCVD, reduce low-density
lipoprotein cholesterol (LDL-C) with high-intensity
statin therapy or maximally tolerated statin therapy. The more LDL-C is reduced on statin therapy, the
greater will be subsequent risk reduction. Use a
maximally tolerated statin to lower LDL-C levels
by $50%.
3. In very high-risk ASCVD, use a LDL-C threshold of 70
mg/dL (1.8 mmol/L) to consider addition of nonstatins to statin therapy. Very high-risk includes a
history of multiple major ASCVD events or 1 major
ASCVD event and multiple high-risk conditions. In
very high-risk ASCVD patients, it is reasonable to add
ezetimibe to maximally tolerated statin therapy when
the LDL-C level remains $70 mg/dL ($1.8 mmol/L). In
patients at very high risk whose LDL-C level
remains $70 mg/dL ($1.8 mmol/L) on maximally
tolerated statin and ezetimibe therapy, adding a
PCSK9 inhibitor is reasonable, although the long-term
safety (>3 years) is uncertain and cost effectiveness is
low at mid-2018 list prices.
4. In patients with severe primary hypercholesterolemia (LDL-C level ‡190 mg/dL [‡4.9 mmol/L]),
without calculating 10-year ASCVD risk, begin highintensity statin therapy. If the LDL-C level
remains $100 mg/dL ($2.6 mmol/L), adding ezetimibe is reasonable. If the LDL-C level on statin plus
ezetimibe remains $100 mg/dL ($2.6 mmol/L) and
the patient has multiple factors that increase subsequent risk of ASCVD events, a PCSK9 inhibitor
may be considered, although the long-term safety
(>3 years) is uncertain and economic value is
uncertain at mid-2018 list prices.
5. In patients 40 to 75 years of age with diabetes mellitus and LDL-C ‡70 mg/dL (‡1.8 mmol/L), start
moderate-intensity statin therapy without calculating 10-year ASCVD risk. In patients with diabetes
mellitus at higher risk, especially those with multiple
risk factors or those 50 to 75 years of age, it is
reasonable to use a high-intensity statin to reduce the
LDL-C level by $50%.
6. In adults 40 to 75 years of age evaluated for primary
ASCVD prevention, have a clinician–patient risk discussion before starting statin therapy. Risk discussion should include a review of major risk factors
(e.g., cigarette smoking, elevated blood pressure,
LDL-C, hemoglobin A1C [if indicated], and calculated
10-year risk of ASCVD); the presence of risk-enhancing
factors (see No. 8); the potential benefits of lifestyle
and statin therapies; the potential for adverse effects
and drug–drug interactions; consideration of costs of
statin therapy; and patient preferences and values in
shared decision-making.
7. In adults 40 to 75 years of age without diabetes
mellitus and with LDL-C levels ‡70 mg/dL (‡1.8
mmol/L), at a 10-year ASCVD risk of $7.5%, start a
moderate-intensity statin if a discussion of treatment
options favors statin therapy. Risk-enhancing factors
favor statin therapy (see No. 8). If risk status is uncertain, consider using coronary artery calcium (CAC)
to improve specificity (see No. 9). If statins are
JACC VOL. 73, NO. 24, 2019 Grundy et al.
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e287
indicated, reduce LDL-C levels by $30%, and if 10-
year risk is $20%, reduce LDL-C levels by $50%.
8. In adults 40 to 75 years of age without
diabetes mellitus and 10-year risk of 7.5% to 19.9%
(intermediate risk), risk-enhancing factors favor
initiation of statin therapy (see No. 7). Riskenhancing factors include family history of premature ASCVD; persistently elevated LDL-C levels
$160 mg/dL ($4.1 mmol/L); metabolic syndrome;
chronic kidney disease; history of preeclampsia or
premature menopause (age <40 years); chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, or chronic HIV); high-risk ethnic groups (e.g.,
South Asian); persistent elevations of triglycerides
$175 mg/dL ($1.97 mmol/L); and, if measured in
selected individuals, apolipoprotein B $130 mg/dL, highsensitivity C-reactive protein $2.0 mg/L, ankle-brachial
index <0.9 and lipoprotein (a) $50 mg/dL or 125 nmol/L,
especially at higher values of lipoprotein (a).
Risk-enhancing factors may favor statin therapy
in patients at 10-year risk of 5-7.5% (borderline risk).
9. In adults 40 to 75 years of age without diabetes
mellitus and with LDL-C levels ‡70 mg/dL- 189 mg/dL
(‡1.8-4.9 mmol/L), at a 10-year ASCVD risk of ‡7.5%
to 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,
except in cigarette smokers, those with diabetes
mellitus, and those with a strong family history of
premature ASCVD. A CAC score of 1 to 99 favors statin
therapy, especially in those $55 years of age. For any
patient, if the CAC score is $100 Agatston units
or $75th percentile, statin therapy is indicated unless
otherwise deferred by the outcome of clinician–
patient risk discussion.
10. Assess adherence and percentage response to LDL-C–
lowering medications and lifestyle changes with
repeat lipid measurement 4 to 12 weeks after statin
initiation or dose adjustment, repeated every 3 to 12
months as needed. Define responses to lifestyle and
statin therapy by percentage reductions in LDL-C
levels compared with baseline. In ASCVD patients at
very high-risk, triggers for adding nonstatin drug
therapy are defined by threshold LDL-C levels $70
mg/dL ($1.8 mmol/L) on maximal statin therapy </s> |
<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 Evaluation and Management
of Patients With Bradycardia and
Cardiac Conduction Delay? [/INST] 2018 ACC/AHA/HRS Guideline on
the Evaluation and Management
of Patients With Bradycardia and
Cardiac Conduction Delay
A Report of the American College of Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines and the Heart Rhythm Society </s> |
<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
MANAGEMENT OF BRADYCARDIA AND
CARDIAC CONDUCTION DELAY? [/INST]
1. Sinus node dysfunction is most often related to agedependent progressive fibrosis of the sinus nodal tissue and surrounding atrial myocardium leading to
abnormalities of sinus node and atrial impulse formation and propagation and will therefore result in
various bradycardic or pause-related syndromes.
JACC VOL. 74, NO. 7, 2019 Kusumoto et al.
AUGUST 20, 2019:e51 – 156 2018 Bradycardia Guideline
e53
2. Both sleep disorders of breathing and nocturnal bradycardias are relatively common, and treatment of
sleep apnea not only reduces the frequency of these
arrhythmias but also may offer cardiovascular benefits. The presence of nocturnal bradycardias should
prompt consideration for screening for sleep apnea,
beginning with solicitation of suspicious symptoms.
However, nocturnal bradycardia is not in itself an
indication for permanent pacing.
3. The presence of left bundle branch block on electrocardiogram markedly increases the likelihood of underlying structural heart disease and of diagnosing
left ventricular systolic dysfunction. Echocardiography is usually the most appropriate initial screening
test for structural heart disease, including left ventricular systolic dysfunction.
4. In sinus node dysfunction, there is no established
minimum heart rate or pause duration where permanent pacing is recommended. Establishing temporal
correlation between symptoms and bradycardia is
important when determining whether permanent
pacing is needed.
5. In patients with acquired second-degree Mobitz type
II atrioventricular block, high-grade atrioventricular
block, or third-degree atrioventricular block not
caused by reversible or physiologic causes, permanent
pacing is recommended regardless of symptoms. For
all other types of atrioventricular block, in the
absence of conditions associated with progressive
atrioventricular conduction abnormalities, permanent
pacing should generally be considered only in the
presence of symptoms that correlate with atrioventricular block.
6. In patients with a left ventricular ejection fraction
between 36% to 50% and atrioventricular block, who
have an indication for permanent pacing and are expected to require ventricular pacing >40% of the time,
techniques that provide more physiologic ventricular
activation (e.g., cardiac resynchronization therapy,
His bundle pacing) are preferred to right ventricular
pacing to prevent heart failure.
7. Because conduction system abnormalities are common after transcatheter aortic valve replacement,
recommendations on postprocedure surveillance and
pacemaker implantation are made in this guideline.
8. In patients with bradycardia who have indications for
pacemaker implantation, shared decision-making and
patient-centered care are endorsed and emphasized in
this guideline. Treatment decisions are based on the
best available evidence and on the patient’s goals of
care and preferences.
9. Using the principles of shared decision-making and
informed consent/refusal, patients with decisionmaking capacity or his/her legally defined surrogate
has the right to refuse or request withdrawal of
pacemaker therapy, even if the patient is pacemaker
dependent, which should be considered palliative,
end-of-life care, and not physician-assisted suicide.
However, any decision is complex, should involve all
stakeholders, and will always be patient specific.
10. Identifying patient populations that will benefit the
most from emerging pacing technologies (e.g., His
bundle pacing, transcatheter leadless pacing systems)
will require further investigation as these modalities
are incorporated into clinical practice. </s> |
<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 Adults With
Congenital Heart Disease? [/INST] 2018 AHA/ACC Guideline for the
Management of Adults With
Congenital Heart Disease
A Report of the American College of Cardiolo </s> |
<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,
Detection, Evaluation, and Management
of High Blood Pressure in Adults ? [/INST] 2017 ACC/AHA/AAPA/ABC/ACPM/
AGS/APhA/ASH/ASPC/NMA/PCNA
Guideline for the Prevention,
Detection, Evaluation, and Management
of High Blood Pressure in Adults </s> |
<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> |
<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
Evaluation and Management of
Patients With Syncope
A Report of the American College of Cardiology/American Heart Association
Task Force on Clinical Practice Guidelines and the Heart Rhythm Society </s> |