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Beta-Blocker Therapy
Î Beta-blocker therapy should be started and continued for 3 years in all
patients with normal LV function after MI or ACS. (I-B)
Î Beta-blocker therapy should be used in all patients with LV systolic
dysfunction (EF ≤40%) with heart failure or prior MI, unless
contraindicated. (Use should be limited to carvedilol, metoprolol
succinate, or bisoprolol, which have been shown to reduce risk of
death.) (I-A)
Î Beta blockers may be considered as chronic therapy for all other
patients with coronary or other vascular disease. (IIb-C)
Renin-Angiotensin-Aldosterone Blocker Therapy
Î ACE inhibitors should be prescribed in all patients with SIHD who also
have hypertension, diabetes mellitus, LVEF ≤40%, or chronic kidney
disease (CKD), unless contraindicated. (I-A)
Î Angiotensin-receptor blockers (ARBs) are recommended for patients
with SIHD who have hypertension, diabetes mellitus, LV systolic
dysfunction, or CKD and have indications for, but are intolerant of, ACE
inhibitors. (I-A)
Î Treatment with an ACE inhibitor is reasonable in patients with both
SIHD and other vascular disease. (IIa-B)
Î It is reasonable to use ARBs in other patients who are ACE inhibitor
intolerant. (IIa-C)
Chelation Therapy (Updated in 2014)
Î The usefulness of chelation therapy is uncertain for reducing
cardiovascular events in patients with SIHD. (IIb-B)
Influenza Vaccination
ÎAn annual influenza vaccine is recommended for patients with SIHD. (I-B)
