The Living Guidelines: Initial Clinical Assessment of Patients Presenting with Heart Failure. Polling Results for CLASS I Guidelines

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Class I Guidelines
1. A thorough history and physical examination should be obtained/performed in patients presenting with HF to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of HF. (Level of Evidence: C)

 ACC / AHA Guidelines for Diagnosis and Management of Chronic Heart Failure: Class I Recommendation 1 for initial clinical assessment of patients presenting with heart failure should be: CLASS I CLASS IIa CLASS IIb CLASS III 2. A careful history of current and past use of alcohol, illicit drugs, current or past standard or “alternative therapies,” and chemotherapy drugs should be obtained from patients presenting with HF. (Level of Evidence: C)

 ACC / AHA Guidelines for Diagnosis and Management of Chronic Heart Failure: Class I Recommendation 2 for initial clinical assessment of patients presenting with heart failure should be: CLASS I CLASS IIa CLASS IIb CLASS III 3. In patients presenting with HF, initial assessment should be made of the patient’s ability to perform routine and desired activities of daily living. (Level of Evidence: C)

 ACC / AHA Guidelines for Diagnosis and Management of Chronic Heart Failure: Class I Recommendation 3 for initial clinical assessment of patients presenting with heart failure should be: CLASS I CLASS IIa CLASS IIb CLASS III 4. Initial examination of patients presenting with HF should include assessment of the patient’s volume status, orthostatic blood pressure changes, measurement of weight and height, and calculation of body mass index. (Level of Evidence: C)

 ACC / AHA Guidelines for Diagnosis and Management of Chronic Heart Failure: Class I Recommendation 4 for initial clinical assessment of patients presenting with heart failure should be: CLASS I CLASS IIa CLASS IIb CLASS III 5. Initial laboratory evaluation of patients presenting with HF should include complete blood count, urinalysis, serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, fasting blood glucose (glycohemoglobin), lipid profile, liver function tests, and thyroid-stimulating hormone. (Level of Evidence: C)

 ACC / AHA Guidelines for Diagnosis and Management of Chronic Heart Failure: Class I Recommendation 5 for initial clinical assessment of patients presenting with heart failure should be: CLASS I CLASS IIa CLASS IIb CLASS III 6. Twelve-lead electrocardiogram and chest radiograph (PA and lateral) should be performed initially in all patients presenting with HF. (Level of Evidence: C)

 ACC / AHA Guidelines for Diagnosis and Management of Chronic Heart Failure: Class I Recommendation 6 for initial clinical assessment of patients presenting with heart failure should be: CLASS I CLASS IIa CLASS IIb CLASS III 7. Two-dimensional echocardiography with Doppler should be performed during initial evaluation of patients presenting with HF to assess LVEF, LV size, wall thickness, and valve function. Radionuclide ventriculography can be performed to assess LVEF and volumes. (Level of Evidence: C)

 ACC / AHA Guidelines for Diagnosis and Management of Chronic Heart Failure: Class I Recommendation 7 for initial clinical assessment of patients presenting with heart failure should be: CLASS I CLASS IIa CLASS IIb CLASS III 8. Coronary arteriography should be performed in patients presenting with HF who have angina or significant ischemia unless the patient is not eligible for revascularization of any kind. (Level of Evidence: B)

 ACC / AHA Guidelines for Diagnosis and Management of Chronic Heart Failure: Class I Recommendation 8 for initial clinical assessment of patients presenting with heart failure should be: CLASS I CLASS IIa CLASS IIb CLASS III