15
Treatment
Stage A
Î Hypertension and lipid disorders should be controlled in accordance
with contemporary guidelines to lower the risk of HF. (I-A)
Î Other 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 Table 11)
Î In 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)
Î In 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
be used to prevent symptomatic HF and cardiovascular events. (I-A)
Î In 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)
Î ACE 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)
Î Beta 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)
Î To prevent sudden death, placement of an implantable cardioverter-
defibrillator (ICD) is reasonable in patients with asymptomatic
ischemic cardiomyopathy who are ≥40 days post-MI, have an LVEF
of ≤30%, are on appropriate medical therapy, and have a reasonable
expectation of survival with a good functional status for
>1 year. (IIa-B)
Î Nondihydropyridine 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)
