Treatment
Stage A
ÎÎHypertension and lipid disorders should be controlled in accordance
with contemporary guidelines to lower the risk of HF. (I-A)
ÎÎOther conditions that may lead to or contribute to HF, such as obesity,
diabetes mellitus, tobacco use, and known cardiotoxic agents, should
be controlled or avoided. (I-C)
Stage B (see Tables 9 and 10)
ÎÎIn all patients with a recent or remote history of MI or acute coronary
syndrome (ACS) and reduced EF, angiotensin-converting enzyme (ACE)
inhibitors should be used to prevent symptomatic HF and reduce
mortality. In patients intolerant of ACE inhibitors, angiotensin-receptor
blockers (ARBs) are appropriate unless contraindicated. (I-A)
ÎÎIn all patients with a recent or remote history of MI or ACS and
reduced EF, evidence-based beta blockers should be used to reduce
mortality. (I-B)
ÎIn all patients with a recent or remote history of MI or ACS, statins should
Î
be used to prevent symptomatic HF and cardiovascular events. (I-A)
ÎÎIn patients with structural cardiac abnormalities, including LV
hypertrophy, in the absence of a history of MI or ACS, blood pressure
should be controlled in accordance with clinical practice guidelines for
hypertension to prevent symptomatic HF. (I-A)
ÎÎACE inhibitors should be used in all patients with a reduced EF to
prevent symptomatic HF, even if they do not have a history of MI. (I-A)
ÎÎBeta blockers should be used in all patients with a reduced EF to
prevent symptomatic HF, even if they do not have a history of MI. (I-C)
ÎÎTo prevent sudden death, placement of an implantable cardioverterdefibrillator (ICD) is reasonable in patients with asymptomatic
ischemic cardiomyopathy who are at least 40 days post-MI, have an
LVEF of 30% or less, are on appropriate medical therapy, and have a
reasonable expectation of survival with a good functional status for
more than 1 year. (IIa-B)
ÎÎNondihydropyridine calcium channel blockers with negative inotropic
effects may be harmful in asymptomatic patients with low LVEF and no
symptoms of HF after MI. (III-C: Harm)
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