Table 3.
Selected Examples of Class I Recommendations Omitted Across 2 Versions of the Same ACC/AHA Clinical Practice Guidelinea
| Index Guideline | Original Recommendation | Class and LOE |
Revised (Current) Guideline From Which Recommendation Was Omitted |
|---|---|---|---|
| 2001: Guidelines for the management of patients with atrial fibrillation18(p1887) | Base selection of pharmacological therapy to maintain sinus rhythm in patients with disabling or otherwise troublesome symptoms during AF predominantly on safety. | Class I, LOE B | 2006: Guidelines for the management of patients with atrial fibrillation19 |
| 2004: Guideline update for coronary artery bypass graft surgery16(pe373) | Blood cardioplegia should be considered in patients undergoing cardiopulmonary bypass accompanying urgent/emergency CABG for acute MI or unstable angina. | Class I, LOE B | 2011: Guideline for coronary artery bypass graft surgery26 |
| 2005: Guideline update for the diagnosis and management of chronic heart failure in the adult29(pe169) | Health care providers should perform a noninvasive evaluation of LV function (ie, LVEF) in patients with a strong family history of cardiomyopathy or in those receiving cardiotoxic interventions. | Class I, LOE C | 2013: Guideline for the management of heart failure30 |
| 2005: Guideline update for the diagnosis and management of chronic heart failure in the adult29(pe196) | Patients with refractory end-stage HF and implantable defibrillators should receive information about the option to inactivate defibrillation. | Class I, LOE C | 2013: Guideline for the management of heart failure30 |
| 2005: Guideline update for the diagnosis and management of chronic heart failure in the adult29(pe199) | Treatment of special populations: groups of patients including (a) high-risk ethnic minority groups (eg, blacks), (b) groups underrepresented in clinical trials, and (c) any groups believed to be underserved should… have clinical screening and therapy in a manner identical to that applied to the broader population. | Class I, LOE B | 2013: Guideline for the management of heart failure30 |
| 2002: Guideline update on perioperative cardiovascular evaluation for noncardiac surgery20(p26) | Coronary angiography in perioperative evaluation before (or after) noncardiac surgery: equivocal noninvasive test results in patients at high clinical risk undergoing high-risk surgery. | Class I | 2007 Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery21 |
| 2002: Guideline update on perioperative cardiovascular evaluation for noncardiac surgery20(p38) | Intraoperative nitroglycerin: high-risk patients previously taking nitroglycerin who have active signs of myocardial ischemia without hypotension. | Class I | 2007 Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery21 |
| 2002: Guideline update for the management of patients with chronic stable angina34(p21) | Echocardiography (resting) for diagnosis of cause of chest pain… evaluation of extent (severity) of ischemia (eg, LV segmental wall motion abnormality) when the echocardiogram can be obtained during pain or within 30 min after its abatement. | Class I, LOE C | 2012: Guideline for the diagnosis and management of patients with stable ischemic heart disease33 |
| 2002: Guideline update for the management of patients with unstable angina and non–ST-segment myocardial infarction36(p64) | Diabetes is an independent risk factor in patients with UA/NSTEMI. | Class I, LOE A | 2007: Guidelines for the management of patients with unstable angina/ non–ST-elevation myocardial infarction35 |
| 1998: Guidelines for the management of patients with valvular heart disease37(p1955) | Radionuclide angiography in aortic regurgitation: confirmation of subnormal LVEF before recommending surgery in an asymptomatic patient with borderline echocardiographic evidence of LV dysfunction. | Class I | 2006: Guidelines for the management of patients with valvular heart disease38 |
| 2007: Evidence-based guidelines for cardiovascular disease prevention in women27(p1486) | If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d. | Class I, LOE B | 2011: Evidence-based guidelines for cardiovascular disease prevention in women28 |
Abbreviations: ACC/AHA, American College of Cardiology/American Heart Association; AF, atrial fibrillation; CABG, coronary artery bypass graft procedure; HF, heart failure; LOE, level of evidence; LV, left ventricle; LVEF, left ventricular ejection fraction; MI, myocardial infarction; UA/NSTEMI, unstable angina/non–ST-segment elevation myocardial infarction.
a
Recommendations have been edited for length; see eTable 2 in the Supplement for full text.