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Cardiovascular disease (CVD) is the leading cause of death in the industrialized world. It is present in approx 50 million Americans, but afflicts close to 1 billion persons worldwide. Increasingly, societies with lesser socioeconomic privilege suffer cardiovascular end points, accounting for as much as 80% of the worldwide CVD burden. The presence of hypertension increases the risk of disease in all atherosclerotic beds by several orders of magnitude. Data from the Framingham Heart Study revealed that among men and women who are normotensive at the age of 55 or 65, the lifetime risk of hypertension is 90%. As the population continues to grow, the number of patients with hypertension will also increase. Consequently, effective management of hypertension is of paramount importance for dampening the imminent growth of CVD during the next century.

Cardiovascular disease (CVD) remains the leading cause of overall mortality in America for both men and women. A major risk factor for CVD is hyperlipidemia, a condition referring to elevated levels of at least one of five families of plasma lipoproteins-chylomicrons, very low-density lipoproteins, intermediate-density lipoproteins, low-density lipoproteins (LDL), and high-density lipoproteins (HDL).

Atrial fibrillation (AF) is a common cardiac arrhythmia. The prevalence of AF increases progressively with age, ranging from about 1% for those under 60 yr of age and increases to more than 8% for those over 80 yr of age. AF is more common in males, with the age-adjusted incidence for women being about half that of men. AF can occur in both the normal heart and the structurally abnormal heart. The cardiac conditions most commonly associated with AF are rheumatic mitral valve disease, ischemic heart disease, congestive cardiomyopathy, and hypertension. Other causes include hyperthyroidism, hypoxic conditions, and alcohol intoxication. The most widely accepted theory in the pathogenesis of AF is believed to be multiple re-entry wavelet mechanism. Patients with AF may be asymptomatic or have symptoms such as palpitations, light-headedness, shortness of breath, and poor exercise tolerance. Some symptoms are related to reduction of cardiac output. Patients with AF are at increased risk for systemic thromboembolism. The absolute risk for stroke is dependent on comorbidities and can range from 1 to 15% per year. The goals in the treatment of AF are to reduce the risk of stroke or other systemic embolus, control the symptoms of palpitations, and improve exercise tolerance.

The following recommendations summarize the anticoagulation guidelines from the seventh American College of Chest Physicians (ACCP) conference on antithrombotic and thrombolytic therapy and employ an evidence grading scale (summarized in Table 5), at the end of the chapter ().

This chapter will concisely summarize the following sections of the anticoagulation guidelines (for management of deep vein thrombosis [DVT]/pulmonary embolism [PE], chapter on DVT/PE):

The recommendations from the American College of Chest Physicians (ACCP) employ a grading system originally described in 2001. If experts are very certain that benefits do, or do not, outweigh risks, burdens, and costs, they will make a strong recommendation (grade 1). If they are less certain of the magnitude of the benefits and the risks, burdens, and costs, and thus of their relative impact, they make a weaker grade 2 recommendation. Consistent results from randomized clinical trial (RCTs) generate grade A recommendations. Observational studies with very strong effects or secure generalizations from RCTs generate grade C+. Inconsistent results from RCTs generate grade B recommendations and observational studies generate grade C recommendations.

Antimicrobial prophylaxis for bacterial endocarditis in select patients has become the standard of medical care in the United States. This practice exists despite the fact that there are no randomized controlled human studies in patients with underlying structural heart disease that definitely establish that antibiotic prophylaxis provides protection against endocarditis during procedures that induce bacteremia. This chapter is based on the recommendations formulated and published by the American Heart Association (AHA) in 1997 (). When the AHA published the recommendations, it was expressly stated that the document was meant as a guideline and is “not intended as the standard of care or as a substitute for clinical judgment.” The 1997 guidelines represent an update from recommendations published by the AHA in 1990.

Asthma is a chronic inflammatory disorder of the airways with episodic airway constriction manifesting as chest tightness, wheezing, and cough, particularly at night and early in the morning. Approximately 14–15 million people in the United States suffer from asthma and it is the most common chronic disease of childhood, with an estimated 4.8 million affected children. Asthma accounts for close to 500,000 hospitalizations each year in the United States and approx 5000 deaths each year.

The Infectious Disease Society of America (IDSA) produced clinical guidelines on the care of community-acquired pneumonia (CAP) in immunocompetent adults in 2000 and 2003 (,). Throughout the guidelines, a grading system is used to categorize the strength of evidence behind various recommendations (), as listed in Table 1.

Acute otitis media (AOM) is one of the most common reasons for sick child visits in the United States. Controversy over its diagnosis and appropriate management has led the American Academy of Pediatrics and American Academy of Family Physicians to author evidence-based clinical practice guidelines. These guidelines are used for the healthy children aged 2 mo to 12 yr. The guidelines do not apply to children with underlying conditions that alter the nature of middle ear disease. Underlying conditions include anatomic abnormalities such as cleft palate and genetic conditions such as Down syndrome, immunodeficiencies, and the presence of cochlear implants.

Acute sinusitis, bronchitis, pharyngitis, and nonspecific upper respiratory tract infections (URIs) account for the majority of antibiotics prescribed by primary care physicians in the United States. The emergence of antibiotic-resistant bacteria in the community setting is now an issue for individual patients as well as society at large, and it is the responsibility of all clinicians to limit antibiotic treatment to those patients who are most likely to benefit from it. The vast majority of acute respiratory infections are caused by viruses. Antibiotic treatment of patients with these infections selects for resistant nasopharyngeal bacteria, acutely increasing the spread of resistant pathogens through secretions and predisposing the treated patient to more serious bacterial infections in the future. The guidelines summarized in this chapter were designed by a panel of physicians representing family medicine, internal medicine, emergency medicine, and infectious diseases to provide a practical approach to the appropriate diagnosis and treatment of previously healthy adults with nonspecific URI, acute sinusitis, or acute bronchitis in the ambulatory care setting. Recommendations for the diagnosis and treatment of pharyngitis are provided in a separate chapter.