These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the Strength of Recommendation Taxonomy (SORT) evidence rating system, go to https://www.aafp.org/afp/2004/0201/p548.html.
1. For patients with stable, intermittent chest pain and no known coronary artery disease (CAD) presenting in the outpatient setting, risk stratification models are helpful to identify those at low risk for CAD for whom additional diagnostic testing can be deferred.
Evidence rating: SORT B
Source: Section One, reference 2 and 9
2.For intermediate- or high-risk patients with stable chest pain and without known CAD, coronary computed tomography angiography (CCTA) and stress testing are effective options for diagnosis of CAD.
Evidence rating: SORT B
Source: Section One, reference 36
3. Echocardiography is recommended in patients with palpitations whose history, physical examination, or electro-cardiography (ECG) findings raise concern for structural heart disease. Echocardiography may be appropriate in patients presenting with palpitations without other signs or symptoms of cardiovascular disease.
Evidence rating: SORT C
Source: Section Two, reference 21
4. Ambulatory ECG monitoring is recommended for unexplained palpitations.
Evidence rating: SORT B
Source: Section Two, reference 7
5.Twelve-lead ECG with history and physical examination, including orthostatic vital signs, is recommended for initial evaluation of syncope. Screening laboratory tests, carotid artery ultrasonography, and echocardiography are not routinely ordered for all patients with syncope.
Evidence rating: SORT B
Sources: Section Three, references 1 and 19
6. Although use of risk stratification tools can be considered for patients with syncope, it is reasonable to use clinician judgment to risk-stratify those in the emergency department because the tools do not increase the accuracy in predicting adverse events.
Evidence rating: SORT B
Source: Section Three, references 1, 2, and 15
7. Medications, including diuretics, are not recommended for lymphedema management.
Evidence rating: SORT B
Source: Section Four, references 34 and 35
8. Patients with edema due to chronic venous insufficiency should be treated with compression therapy using elas-tic compression stockings, inelastic bandages, or adjustable compression garments that exert a pressure of 20 to 40 mm Hg.
Evidence rating: SORT B
Source: Section Four, references 29 and 32
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