The Living Guidelines: STEMI Recommendations for Additional Management Considerations for Beta Blocker Therapy Polling Results for CLASS I Guidelines

1. Oral beta-blocker therapy should be initiated in the first 24 h for patients who do not have any of the following: Class I, Level of Evidence: B


 * Signs of heart failure,


 * Evidence of a low output state,


 * Increased risk for cardiogenic shock are age >70 years, systolic blood pressure <120 mm Hg, sinus tachycardia >110 bpm or heart rate <60 bpm, and increased time since onset of symptoms of STEMI (the greater the number of risk factors present, the higher the risk of developing cardiogenic shock),


 * Other relative contraindications to beta blocker therapy (PR interval >0.24 seconds, second or third degree AV block, active asthma, or reactive airway disease).

 Beta Blocker Therapy CLASS I Recommendation 1 should be: CLASS I CLASS IIa CLASS IIb CLASS III

2. Patients with early contraindications within the first 24 h of STEMI should be re-evaluated for beta blocker therapy as secondary prevention Class I, Level of Evidence: C

 Beta Blocker Therapy CLASS I Recommendation 2 should be: CLASS I CLASS IIa CLASS IIb CLASS III

3. Patients with moderate or severe Left Ventricular failure should receive beta blocker therapy as secondary prevention with a gradual titration scheme. Class I, Level of Evidence: B

 Beta Blocker Therapy CLASS I Recommendation 3 should be: CLASS I CLASS IIa CLASS IIb CLASS III