2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant)

Since the 1995 publication of its Core Cardiovascular Training Statement (COCATS),1 the American College of Cardiology (ACC) has played a central role in defining the knowledge, experiences, skills, and behaviors expected of all clinical cardiologists upon completion of training. Subsequent updates have incorporated major advances and revisions—both in content and structure—including, most recently,

Dyslipidemia: Current Therapies And Guidelines For Treatment

Despite significant advances in prevention and treatment, cardiovascular disease continues to be the leading cause of morbidity and mortality in the United States and worldwide. Nevertheless, the mortality from cardiovascular disease has decreased dramatically over the past few decades. Among the modifiable risk factors, dyslipidemia is a leading contributor to the development of coronary heart disease, and cholesterol-lowering treatment, primarily with statins, has been considered responsible for improvements in cardiovascular outcomes over the past 20 years. As such, physicians and researchers are frequently reevaluating the optimal approach and recommendations for cholesterollowering therapy for the primary prevention of cardiovascular disease. The objectives of this article are to review the evidence and efficacy of cholesterol-lowering therapies and to examine the current major societal guidelines for the management of dyslipidemia and appropriate patient selection

The clinical value of single photon emission computed tomography myocardial perfusion imaging in cardiac risk stratification of very elderly patients (≥80 years) with suspected coronary artery disease.

BACKGROUND: The role of single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) in cardiac evaluation of the very elderly patients is unclear. We investigated the clinical value of SPECT MPI in very elderly patients (≥80 years) with suspected coronary artery disease (CAD) as well as in comparison to younger patients. METHODS AND RESULTS: A retrospective analysis of prospectively collected data from 8,864 patients [1,093 patients ≥80 years (very elderly), 3,369 patients 65-79 years (elderly), and 4,402 patients 50-64 years (middle-aged)] with suspected CAD who underwent exercise and/or pharmacologic stress testing with SPECT MPI between 1996 and 2005 was performed. Clinical and SPECT MPI characteristics, cardiac event rates, early (≤60 days) cardiac catheterization and revascularization rates of very elderly patients were compared to that of younger patients. Mean follow-up for cardiac events (cardiac death or non-fatal myocardial infarction) was 1.9 ± 0.9 years. Very elderly patients with moderate to severely abnormal SSS had a significantly higher annualized cardiac event rate than those with mildly abnormal or normal study (9.6% vs 3.4% and 2.5% respectively, P \u3c .001). Across all categories of SSS, very elderly patients had a significantly higher cardiac event rate as compared to younger patients (P \u3c .001). Early cardiac catheterization and revascularization referrals in very elderly patients increased as a function of severity of ischemia on SPECT MPI (P \u3c .001), although these referral rates were significantly lower in very elderly patients with mild to moderate and severe ischemia as compared to younger patients (P \u3c .05). CONCLUSIONS: In very elderly patients (≥80 years) with suspected CAD, SPECT MPI has prognostic and incremental value in the noninvasive cardiovascular assessment for risk stratification and may influence medical decisions