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Treatment
6.1. Management of Stage B: Preventing the Syndrome of
Clinical HF in Patients With Pre-HF
COR LOE
Recommendations
1 A 1. In patients with LVEF ≤40%, ACEi should be used to prevent
symptomatic HF and reduce mortality.
1 A 2. In patients with a recent or remote history of MI or ACS,
statins should be used to prevent symptomatic HF and adverse
cardiovascular events.
1 B-R 3. In patients with a recent MI and LVEF ≤40% who are
intolerant to ACEi, ARB should be used to prevent
symptomatic HF and reduce mortality.
1 B-R 4. In patients with a recent or remote history of MI or acute
coronary syndrome (ACS) and LVEF ≤40%, evidence-based
beta blockers should be used to reduce mortality.
1 B-R 5. In patients who are at least 40 days post-MI with LVEF
≤30% and NYHA class I symptoms while receiving GDMT
and have reasonable expectation of meaningful survival for
>1 year, an ICD is recommended for primary prevention of
sudden cardiac death (SCD) to reduce total mortality.
1 C-LD 6. In patients with LVEF ≤40%, beta blockers should be used to
prevent symptomatic HF.
3: Harm B-R 7. In patients with LVEF <50%, thiazolidinediones should
not be used because they increase the risk of HF, including
hospitalizations.
3: Harm C-LD 8. In patients with LVEF <50%, nondihydropyridine calcium
channel blockers with negative inotropic effects may be
harmful.
6. Stage B (Patients With Pre-HF)
