Clinical Cardiology
Current Practice Guidelines
Demosthenes G. Katritsis, MD, PhD, FRCP, FACC
Hygeia Hospital, Athens, Greece
Johns Hopkins Medicine, Baltimore, MD, USA
ΠΑΝΤΕΣ ΑΝΘΡΩΠΟΙ ΤΟΥ ΕΙΔΕΝΑΙ ΟΡΕΓΟΝΤΑΙ ΦΥΣΕΙ
All humans by nature desire to know
Aristotle
The Metaphysics
Prologue
The field of cardiovascular medicine has entered an era of rapid scientific progress, accompanied by continuous advances in technology and clinical practice. At the same time, there is an increasing emphasis on evidence-based medicine and a steady stream of new guidelines from major professional societies. While these developments have greatly expanded the body of medical knowledge, they also create growing challenges for practicing clinicians, who must keep up with an ever-increasing amount of information alongside their demanding clinical responsibilities.
To practice evidence-based medicine effectively, information needs to be not only reliable and up to date, but also easily accessible and, more importantly, easy to retrieve when it is needed. This is becoming increasingly difficult as medical knowledge continues to expand at an unprecedented pace, even with the help of modern AI tools.
The rationale for this book arises directly from this need, both for clinicians and for potential readers. Its aim is to organize the constantly evolving knowledge of cardiology, including issues that are often diverse and complex, in a way that takes advantage of today’s highly connected and accessible information environment. In practical terms, the book is intended to serve as a clinical tool for everyday practice: a concise guide to what is known, what remains uncertain, and, importantly, what may only appear to be known. Informed clinical practice requires several essential elements: a solid understanding of disease entities; awareness of important clinical trials and emerging scientific evidence that influence current approaches to diagnosis and treatment; and familiarity with the latest practice guidelines from established professional societies, including the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and the European Society of Cardiology (ESC), among others.
For this reason, each chapter is organized around the following main components:
1. Definition, classification, epidemiology, and pathophysiology.
Each chapter begins with a clear definition and contemporary classification of the disease or condition, followed by focused, up-to-date information on its epidemiology and pathophysiology. Recent original studies and review articles from leading journals have been considered, with the most clinically relevant information summarized. Particular attention has been given to medical genetics, an increasingly important and promising area of cardiovascular medicine.
2. Clinical presentation and diagnostic evaluation.
The clinical presentation of each condition is described, together with practical guidance on the investigations that may be required. Diagnostic tests are discussed in the context of current evidence, including evidence that has changed their perceived value or, in some cases, made them less relevant. The latest evidence on the clinical usefulness of both established and emerging diagnostic tests is also included, based on randomized clinical trials and current ACCF/AHA and ESC guidelines.
3. Evidence-based management.
Management recommendations are based on the most recent evidence available. Given the extensive number of guidelines produced by professional societies such as the ACC, AHA, and ESC, the most important recommendations are also summarized in a practical, tabulated format. Keeping track of these recommendations is not always straightforward. Different working groups may publish overlapping guidelines for the same condition, while updated documents and new scientific statements continue to appear. Relevant guideline documents, updates, and scientific statements published in the United States and Europe have therefore been reviewed and organized according to their year of publication. The most recent recommendations have been identified, extracted, and presented in tables. These tables provide a practical overview of the latest ACC/AHA and ESC recommendations for each disease entity, as reflected in new and updated guidelines. Where appropriate, new evidence that challenges specific recommendations, expert opinions, and other relevant information, including FDA safety alerts, are also highlighted.
4. Practical advice: “what to do and why.”
The book is intended to be useful at the bedside and in everyday clinical practice. Treatment strategies, drug selection and dosing, and procedural options are therefore presented in a clear and user-friendly way, with emphasis on what clinicians need to know and why.
5. Carefully selected references.
Major randomized clinical trials and landmark scientific studies that have shaped evidence-based cardiovascular practice are included for further reading. Recent, high-quality reviews are also provided, allowing readers to explore specific topics in greater depth when needed.
6. Recent guidelines and scientific statements.
Current guidelines and scientific statements from the ACC, AHA, and ESC are referenced and presented separately at the beginning of each relevant section of the book. Recent comprehensive position papers from working groups and affiliated organizations are also included or discussed where appropriate.
One of the unavoidable limitations of any medical textbook is its inability to remain fully up to date as new evidence emerges. To address this problem, the online version of the book is updated as required, allowing readers to keep pace with important developments in cardiovascular medicine.