Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 013

59y·male·white·ASCVD 29.3% · SBP 155 mmHg · LVEF 35% · Chol 212 mg/dL

2 active reversal flags

  1. CardiologyCritical

    Class 1C antiarrhythmics post-myocardial infarction

    Why flagged

    Class 1C antiarrhythmic (flecainide/encainide) contraindicated: patient has structural heart disease or prior MI; CAST 1989 showed 2.5x increase in cardiovascular mortality.

    1. Prior guidance1989

      Routine use of Class 1C antiarrhythmics to suppress PVCs following myocardial infarction to prevent sudden death (Pre-1989 standard of care).

    2. CAST1989

      Flecainide and Encainide increased cardiovascular mortality risk 2.5 times (RR 2.5; 95% CI 1.7-8.5) compared to placebo.

    3. Reversal1992

      Guidelines updated

    4. Current recommendation

      ACC/AHA guidelines: Absolute contraindication for Class 1C antiarrhythmics (flecainide, encainide) in patients with prior MI or structural heart disease.

  2. CardiologyModerate

    Routine PCI for stable coronary artery disease

    Why flagged

    Elective PCI referral for stable CAD; COURAGE 2007 showed no mortality benefit over OMT alone. Recommend OMT-first review before proceeding.

    1. Prior guidance2007

      Routine PCI and stenting for significant angiographic stenoses (> 70%) in stable CAD to prevent death and myocardial infarction (Pre-2007 consensus).

    2. COURAGE2007

      PCI + OMT showed no difference in all-cause death or nonfatal MI compared to OMT alone (19.0% vs. 18.5%, p=NS).

    3. Reversal2023

      Guidelines updated

    4. Current recommendation

      ACC/AHA Guidelines: Optimal medical therapy (OMT) is the primary management strategy for stable ischemic heart disease. PCI is indicated strictly for refractory anginal symptom relief, not mortality reduction.