ACE inhibitors are recommended in patients with HFrEF and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality (134,167 169). (Level of Evidence: A) Table 9. Recommendations for Treatment of Stage B HF Recommendations COR LOE References In patients with a history of MI and reduced EF, ACE inhibitors or ARBs should be used to prevent HF I A 132 136 In patients with MI and reduced EF, evidence-based beta blockers should be used to prevent HF I B 137 139 In patients with MI, statins should be used to prevent HF I A 140 146 Blood pressure should be controlled to prevent symptomatic HF I A 28,128 131 ACE inhibitors should be used in all patients with a reduced EF to prevent HF I A 135,147 Beta blockers should be used in all patients with a reduced EF to prevent HF I C N/A An ICD is reasonable in patients with asymptomatic ischemic cardiomyopathy who are at least 40 d post-MI, have an LVEF 30%, and on GDMT IIa B 148 Nondihydropyridine calcium channel blockers may be harmful in patients with low LVEF III: Harm C N/A ACE indicates angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; COR, Class of Recommendation; EF, ejection fraction; GDMT, guideline-directed medical therapy; HF, heart failure; ICD, implantable cardioverter-defibrillator; LOE, Level of Evidence; LVEF, left ventricular ejection fraction; MI, myocardial infarction; and N/A, not available. Yancy et al. JACC Vol. 62, No. 16, 2013 2013 ACCF/AHA Heart Failure Guidelines: Executive Summary October 15, 2013:1495 539 6.3.2.3. ANGIOTENSIN-RECEPTOR BLOCKERS CLASS I 1. ARBs are recommended in patients with HFrEF with current or prior symptoms who are ACE inhibitor intolerant, unless contraindicated, to reduce morbidity and mortality (136,170,171,189). (Level of Evidence: A) CLASS IIa 1. 