Jensen Xa 1120 Manual Treadmill

• Jensen Xa 1120 Manual Treadmill Manual

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. Peri-operative and post-operative morbidity and mortality, including side effects of anesthetic medications. Short- and long-term complications of valve repair and replacement including thromboembolic risks. Bleeding complications associated with anticoagulant therapy. Side effects of cardiovascular drugs. False-negative results of transesophageal echocardiography (TEE).

Major complications can occur during pregnancy in patients with prosthetic valves. The increased hemodynamic burden of pregnancy can lead to heart failure if there is prosthetic valve thrombosis, stenosis, regurgitation, or patient-prosthesis mismatch. There is an increased risk for thrombosis of mechanical valves due to the hypercoagulable state of pregnancy. Because the American College of Cardiology (ACC)/American Heart Association (AHA) practice guidelines address patient populations (and clinicians) residing in North America, drugs that are not currently available in North America are discussed in the text without a specific class of recommendation (COR). For studies performed in large numbers of subjects outside North America, each writing committee reviews the potential impact of different practice patterns and patient populations on the treatment effect and relevance to the ACC/AHA target population to determine whether the findings should inform a specific recommendation. The ACC/AHA practice guidelines are intended to assist clinicians in clinical decision making by describing a range of generally acceptable approaches to the diagnosis, management, and prevention of specific diseases or conditions. The guidelines attempt to define practices that meet the needs of most patients in most circumstances.

The ultimate judgment about care of a particular patient must be made by the clinician and patient in light of all the circumstances presented by that patient. As a result, situations may arise in which deviations from these guidelines may be appropriate. Clinical decision making should involve consideration of the quality and availability of expertise in the area where care is provided. When these guidelines are used as the basis for regulatory or payer decisions, the goal should be improvement in quality of care. The Task Force recognizes that situations arise in which additional data are needed to inform patient care more effectively; these areas are identified within each respective guideline when appropriate. Prescribed courses of treatment in accordance with these recommendations are effective only if followed.

Because lack of patient understanding and adherence may adversely affect outcomes, clinicians should make every effort to engage the patient's active participation in prescribed medical regimens and lifestyles. In addition, patients should be informed of the risks, benefits, and alternatives to a particular treatment and should be involved in shared decision making whenever feasible, particularly for COR IIa and IIb, for which the benefit-to-risk ratio may be lower. An extensive review was conducted on literature published through November 2012, and other selected references through October 2013 were reviewed by the guideline writing committee.

Searches were extended to studies, reviews, and other evidence conducted on human subjects and that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected databases relevant to this guideline. Key search words included but were not limited to the following: valvular heart disease, aortic stenosis, aortic regurgitation, bicuspid aortic valve, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation, pulmonic stenosis, pulmonic regurgitation, prosthetic valves, anticoagulation therapy, infective endocarditis, cardiac surgery, and transcatheter aortic valve replacement. Additionally, the committee reviewed documents related to the subject matter previously published by the American College of Cardiology (ACC) and American Heart Association (AHA). The references selected and published in this document are representative and not all-inclusive.

In analyzing the data and developing recommendations and supporting text, the writing committee uses evidence-based methodologies developed by the Task Force. The Level of Evidence (LOE) is an estimate of the certainty or precision of the treatment effect. The writing committee reviews and ranks evidence supporting each recommendation, with the weight of evidence ranked as LOE A, B, or C, according to specific definitions that are included in the 'Rating Scheme for the Strength of the Evidence' field. Studies are identified as observational, retrospective, prospective, or randomized where appropriate. Experts in the subject under consideration are selected from both the American College of Cardiology (ACC) and the American Heart Association (AHA) to examine subject-specific data and write guidelines. Writing committees are specifically charged with performing a literature review; weighing the strength of evidence for or against particular tests, treatments, or procedures; and including estimates of expected health outcomes where such data exist.

Patient-specific modifiers, comorbidities, and issues of patient preference that may influence the choice of tests or therapies are considered, as well as frequency of follow-up and cost effectiveness. When available, information from studies on cost is considered; however, a review of data on efficacy and outcomes constitutes the primary basis for preparing recommendations in this guideline. In analyzing the data and developing recommendations and supporting text, the writing committee uses evidence-based methodologies developed by the Task Force. The Class of Recommendation (COR) is an estimate of the size of the treatment effect, with consideration given to risks versus benefits, as well as evidence and/or agreement that a given treatment or procedure is or is not useful/effective or in some situations may cause harm. The writing committee reviews and ranks evidence supporting each recommendation, with the weight of evidence ranked as Level of Evidence (LOE) A, B, or C, according to specific definitions that are included in the 'Rating Scheme for the Strength of the Evidence' field. Studies are identified as observational, retrospective, prospective, or randomized, as appropriate. For certain conditions for which inadequate data are available, recommendations are based on expert consensus and clinical experience and are ranked as LOE C.

When recommendations at LOE C are supported by historical clinical data, appropriate references (including clinical reviews) are cited if available. For issues with sparse available data, a survey of current practice among the clinician members of the writing committee is the basis for LOE C recommendations and no references are cited. A new addition to this methodology is separation of the Class III recommendations to delineate whether the recommendation is determined to be of 'no benefit' or is associated with 'harm' to the patient. In addition, in view of the increasing number of comparative effectiveness studies, comparator verbs and suggested phrases for writing recommendations for the comparative effectiveness of one treatment or strategy versus another are included for COR I and IIa, LOE A or B only.

In view of the advances in medical therapy across the spectrum of cardiovascular diseases, the Task Force has designated the term guideline-directed medical therapy (GDMT) to represent optimal medical therapy as defined by ACC/AHA guideline (primarily Class I)-recommended therapies. This new term, GDMT, is used herein and throughout subsequent guidelines. Because the ACC/AHA practice guidelines address patient populations (and clinicians) residing in North America, drugs that are not currently available in North America are discussed in the text without a specific COR.

For studies performed in large numbers of subjects outside North America, each writing committee reviews the potential impact of different practice patterns and patient populations on the treatment effect and relevance to the ACC/AHA target population to determine whether the findings should inform a specific recommendation. Organization of the Writing Committee The committee was composed of clinicians, who included cardiologists, interventionalists, surgeons, and anesthesiologists. The committee also included representatives from the American Association for Thoracic Surgery, American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons (STS). Writing Committee Members: Rick A. Nishimura, MD, MACC, FAHA ( Co-chair), ACC/AHA representative; Catherine M.

Otto, MD, FACC, FAHA ( Co-chair), ACC/AHA representative; Robert O. Bonow, MD, MACC, FAHA, ACC/AHA representative; Blase A.

Carabello, MD, FACC, ACC/AHA representative; John P. Erwin III, MD, FACC, FAHA, ACC/AHA Task Force on Performance Measures liaison; Robert A. Guyton, MD, FACC, ACC/AHA Task Force on Practice Guidelines liaison; Patrick T. O'Gara, MD, FACC, FAHA, ACC/AHA representative; Carlos E. Ruiz, MD, PhD, FACC, ACC/AHA representative; Nikolaos J.

Skubas, MD, FASE, Society of Cardiovascular Anesthesiologists representative; Paul Sorajja, MD, FACC, FAHA, Society for Cardiovascular Angiography and Interventions representative; Thoralf M. Sundt III, MD, American Association for Thoracic Surgery representative, Society of Thoracic Surgeons representative; James D. Thomas, MD, FASE, FACC, FAHA, American Society of Echocardiography representative Task Force Members: Jeffrey L. Anderson, MD, FACC, FAHA ( Chair); Jonathan L. Halperin, MD, FACC, FAHA ( Chair-elect); Nancy M. Albert, PhD, CCNS, CCRN, FAHA; Biykem Bozkurt, MD, PhD, FACC, FAHA; Ralph G.

Brindis, MD, MPH, MACC; Mark A. Creager, MD, FACC, FAHA.; Lesley H.

Curtis, PhD, FAHA; David DeMets, PhD; Robert A. Guyton, MD, FACC.; Judith S. Hochman, MD, FACC, FAHA; Richard J. Kovacs, MD, FACC, FAHA; E. Magnus Ohman, MD, FACC; Susan J. Pressler, PhD, RN, FAHA; Frank W.

Sellke, MD, FACC, FAHA; Win-Kuang Shen, MD, FACC, FAHA; William G. Stevenson, MD, FACC, FAHA.; Clyde W. Yancy, MD, FACC, FAHA.Former Task Force member during the writing effort. The Task Force makes every effort to avoid actual, potential, or perceived conflicts of interest that may arise as a result of relationships with industry and other entities (RWI) among the members of the writing committee.

All writing committee members and peer reviewers of the guideline are required to disclose all current healthcare-related relationships, including those existing 12 months before initiation of the writing effort. In December 2009, the American College of Cardiology (ACC) and the American Heart Association (AHA) implemented a new RWI policy that requires the writing committee chair plus a minimum of 50% of the writing committee to have no relevant RWI (Appendix 1 in the original guideline document includes the ACC/AHA definition of relevance). The Task Force and all writing committee members review their respective RWI disclosures during each conference call and/or meeting of the writing committee, and members provide updates to their RWI as changes occur. All guideline recommendations require a confidential vote by the writing committee and require approval by a consensus of the voting members. Authors' and peer reviewers' RWI pertinent to this guideline are disclosed in Appendixes 1 and 2 in the original guideline document. Members may not draft or vote on any recommendations pertaining to their RWI. Members who recused themselves from voting are indicated in the list of writing committee members with specific section recusals noted in Appendix 1 in the original guideline document.

In addition, to ensure complete transparency, writing committee members' comprehensive disclosure information—including RWI not pertinent to this document—is available as an online supplement. Comprehensive disclosure information for the Task Force is also available online. The ACC and AHA exclusively sponsor the work of the writing committee without commercial support. Writing committee members volunteered their time for this activity. Guidelines are official policy of both the ACC and AHA. This is the current release of the guideline.

This guideline updates a previous version: Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines trunc. J Am Coll Cardiol. 2008 Sep 23;52(13):e1-142.

1067 references. The following are available:. Hiratzka LF, Nishimura RA, Bonow RO, Creager MA, Guyton RA, Isselbacher EM, Sundt TM 3rd, Svensson LG. Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016;67:724–31.

Available from the. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD.

2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jun 10;63(22):2438-88.

Electronic copies: Available from the. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease.

A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Online data supplement. Available from the. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Ten points to remember. Electronic copies: Available from the. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Electronic copies: Available to subscribers from the. Methodology manual and policies from the ACCF/AHA Task Force on Practice Guidelines. American College of Cardiology Foundation and American Heart Association, Inc. Electronic copies: Available from the. Print copies: Available from the American College of Cardiology, 2400 N Street NW, Washington DC, 20037; (800) 253-4636 (US only). This NGC summary was completed by ECRI on July 26, 1999. The information was verified by the guideline developer on October 15, 1999.

Jensen Xa 1120 Manual Treadmill Manual

This summary was updated by ECRI on August 3, 2006. The information was verified by the guideline developer on August 17, 2006. This summary was updated by ECRI on March 6, 2007 following the U.S. Food and Drug Administration (FDA) advisory on Coumadin (warfarin sodium).

This summary was updated by ECRI Institute on June 22, 2007 following the U.S. Food and Drug Administration (FDA) advisory on heparin sodium injection. This summary was updated by ECRI Institute on September 7, 2007 following the revised U.S.

Food and Drug Administration (FDA) advisory on Coumadin (warfarin). This summary was updated by ECRI Institute on March 14, 2008, April 22, 2009 following the updated FDA advisory on heparin sodium injection. This summary was updated by ECRI Institute on July 13, 2009. The updated information was verified by the guideline developer on July 23, 2009. This summary was updated by ECRI Institute on January 5, 2010 following the U.S. Food and Drug Administration advisory on Plavix (Clopidogrel). This summary was updated by ECRI Institute on May 17, 2010 following the U.S.

Food and Drug Administration advisory on Plavix (clopidogrel). This summary was updated by ECRI Institute on July 27, 2010 following the FDA drug safety communication on Heparin.

This summary was updated by ECRI Institute on August 7, 2014. The updated information was verified by the guideline developer on September 24, 2014.

Note from the National Guideline Clearinghouse (NGC) and the American College of Cardiology (ACC) and the American Heart Association (AHA): Two guidelines from the ACC, the AHA, and collaborating societies address the risk of aortic dissection in patients with bicuspid aortic valves and severe aortic enlargement: the '2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease' and the '2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease.' However, the 2 guidelines differ with regard to the recommended threshold of aortic root or ascending aortic dilatation that would justify surgical intervention in patients with bicuspid aortic valves. The ACC and AHA therefore convened a subcommittee representing members of the 2 guideline writing committees to review the evidence, reach consensus, and draft a statement of clarification for both guidelines.

This statement of clarification uses the ACC/AHA revised structure for delineating the Class of Recommendation and Level of Evidence to provide recommendations that replace the intervention recommendations in the Bicuspid Aortic Valve section, below. See the ACC/AHA Statement of Clarification in the 'Availability of Companion Documents' field.

Definitions for the levels of the evidence ( A–C) and classes of recommendations ( I–III) are provided at the end of the 'Major Recommendations' field. The following algorithms are provided in the original guideline document:.

Indications for AVR in Patients with AS. Indications for AVR for Chronic AR. Indications for Intervention for Rheumatic MS. Indications for Surgery for MR. Indications for Surgery. Anticoagulation for Prosthetic Valves. Evaluation and Management of Suspected Prosthetic Valve Thrombosis.

Diagnosis and Treatment of IE. Anticoagulation of Pregnant Patients with Mechanical Valves. Evaluation and Management of CAD in Patients Undergoing Valve Surgery. Intra-aortic balloon counterpulsation is contraindicated in patients with acute severe aortic regurgitation (AR). Cardiac magnetic resonance imaging is contraindicated in patients with implanted devices. The presence of either severe and uncorrectable pulmonary hypertension or significant right ventricular (RV) dysfunction constitutes a relative contraindication to reoperation for isolated tricuspid valve repair or replacement. Aspirin intolerance or history of bleeding is a contraindication to use of aspirin in combination with a vitamin K antagonist (VKA).

Food and Drug Administration (FDA) has issued a specific contraindication for use of dabigatran in patients with mechanical heart valves. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are contraindicated during pregnancy due to fetal toxicity, including renal or tubular dysplasia, oligohydramnios, growth retardation, ossification disorders of the skull, lung hypoplasia, and intrauterine fetal death. Macrolide antibiotics should not be used in persons taking other medications that inhibit cytochrome P450 3A, such as azole antifungal agents, human immunodeficiency virus (HIV) protease inhibitors, and some selective serotonin reuptake inhibitors.