The Living Guidelines: Patients with Cardiac Structural Abnormalities or Remodeling who have not Developed Heart Failure Symptoms. Suggest Revisions to the CLASS III Guidelines

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Class III Guidelines
1. Digoxin should not be used in patients with low EF, sinus rhythm, and no history of HF symptoms, because in this population, the risk of harm is not balanced by any known benefit. (Level of Evidence: C)

2. Use of nutritional supplements to treat structural heart disease or to prevent the development of symptoms of HF is not recommended. (Level of Evidence: C)

3. Calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of HF after MI (Patients in Stage C). (Level of Evidence: C)