Carl R. Reynolds, MD; Mariell Jessup, MD
The first 3 boxes show the progression to the next step of care; the information that flows from the third box, “Reassess EF and ECG and clinical status,” indicated a stepwise progression that is well supported by strong evidence from randomized, controlled trials. The dashed arrow indicates a step that has weak justification from current data. ACE = angiotensin-converting enzyme; ARB = angiotensin-receptor blocker; CRT-D = CRT with defibrillator; CRT-P = CRT with pacing only; ECG = electrocardiography; EF = ejection fraction; ICD = implantable cardioverter-defibrillator; NYHA = New York Heart Association.
* The 2008 American College of Cardiology/American Heart Association guidelines (17) stipulate that patients have NYHA class II symptoms and an EF ≤0.35 to be eligible for ICD implantation but allow patients with NYHA class I symptoms and concomitant EF ≤0.30 and ischemic cause (>40 d after myocardial infarction) to be eligible for this therapy.
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Carl R. Reynolds, Mariell Jessup. Translating the Benefits of Cardiac Resynchronization Therapy Widely and Wisely: Challenges Remain. Ann Intern Med. 2011;154:436–438. doi: 10.7326/0003-4819-154-6-201103150-00314
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Published: Ann Intern Med. 2011;154(6):436-438.
Cardiology, Heart Failure.
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