NICE guidance - beta blockers following myocardial infarction (MI)

NICE have issued guidance as to the use of beta blockers post myocardial infarction (1):

• offer people a beta-blocker as soon as possible after an MI, when the person is haemodynamically stable
  
  
• communicate plans for titrating beta-blockers up to the maximum tolerated or target dose – for example, in the discharge summary
  
  
• consider continuing a beta-blocker for 12 months after an MI for people without reduced left ventricular ejection fraction

• discuss the potential benefits and risks of stopping or continuing beta-blockers beyond 12 months after an MI for people without reduced left ventricular ejection fraction. Include in the discussion:
  • the lack of evidence on the relative benefits and harms of continuing beyond 12 months
  • the person's experience of adverse effects
    
    
• continue a beta-blocker indefinitely in people with reduced left ventricular ejection fraction

• offer all people who have had an MI more than 12 months ago, who have reduced left ventricular ejection fraction, a beta-blocker whether or not they have symptoms. For people with heart failure plus reduced left ventricular ejection fraction, manage the condition in line with the NICE guideline on chronic heart failure in adults
  
  
• do not offer people without reduced left ventricular ejection fraction or heart failure, who have had an MI more than 12 months ago, treatment with a beta-blocker unless there is an additional clinical indication for a beta-blocker

Reference:

1. NICE (2020). Acute coronary syndromes