The Living Guidelines: STEMI Recommendations for Beta Blocker Therapy Suggest Revisions to the CLASS I Guidelines

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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 a- Signs of heart failure, b- Evidence of a low output state, c- 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), d- Other relative contraindications to beta blocker therapy (PR interval >0.24 seconds, second or third degree AV block, active asthma, or reactive airway disease).
 * 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
 * 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