Class III C recommendations in guidelines for cardiovascular medicine

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Class III Recommendations in Guidelines for Cardiovascular Medicine

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List of All Class III Recommendations

Organized by Guideline
Guideline Keywords
Year of Guideline Publication
Organized by Level of Evidence
LOE: A
LOE: B
LOE: C
Unclassified LOE

List of Guidelines

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Aparna Vuppala, M.B.B.S. [2]

Overview

LOE C is defined as evidence obtained from either a very limited number of populations, consensus opinion of experts, case studies, or standard of care. The total number of class III-LOE C recommendations in guidelines published by American cardiology societies is 277.

Class III C Recommendations: Organized by Guideline Keywords

The table shown below is a list of class III C recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by guideline name/keywords in alphabetical order. Alternatively, to view the same list organized by year of guideline publication, click here.

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

Class III C Recommendations: Organized by Year of Guideline Publication

The table shown below is a list of class III C recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by year of guideline publication. Alternatively, to view the same list organized by guideline name/keywords, click here.

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