The Living Guidelines: UA/NSTEMI Recommendations for Inhibition of the Renin-Angiotensin-Aldosterone System Polling Results for CLASS I Guidelines

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Class I Guidelines
1. Angiotensin-converting enzyme inhibitors should be given and continued indefinitely for patients recovering from UA/NSTEMI with HF, LV dysfunction (LV EF <40%), hypertension, or diabetes mellitus, unless contraindicated. (Level of Evidence: A)

 UA/NSTEMI Guidelines Class I Recommendation 1 for Inhibition of the Renin-Angiotensin-Aldosterone System should be: CLASS I CLASS IIa CLASS IIb CLASS III

2. An angiotensin receptor blocker should be prescribed at discharge to those UA/NSTEMI patients who are intolerant of an ACE inhibitor and who have either clinical or radiological signs of HF and LV EF <40%. (Level of Evidence: A)

 UA/NSTEMI Guidelines Class I Recommendation 2 for Inhibition of the Renin-Angiotensin-Aldosterone System should be: CLASS I CLASS IIa CLASS IIb CLASS III

3. Long term Aldosterone Receptor Blockade should be prescribed for UA/NSTEMI patients without significant renal dysfunction (estimated creatinine clearance should be >30 mL/min) or hyperkalemia (potassium should be ≤5 mEq/liter) who are already receiving therapeutic doses of an ACE inhibitor, have an LV EF ≤40%, and have either symptomatic heart failure or diabetes mellitus. (Level of Evidence: A)

 UA/NSTEMI Guidelines Class I Recommendation 3 for Inhibition of the Renin-Angiotensin-Aldosterone System should be: CLASS I CLASS IIa CLASS IIb CLASS III