Beta blockers for secondary prevention of atherosclerotic cardiovascular events

While beta-blocker therapy should be started immediately following an acute coronary syndrome (unless contraindicated), routine long-term use of a beta blocker is no longer recommended in all patients.

The benefit of long-term beta-blocker therapy in patients with successful revascularisation, preserved left ventricular function and no angina, is likely to be small; in these patients, stop beta-blocker therapy after 12 months, or earlier if there are adverse effectsChew, 2016.

Patients with ongoing ischaemia (including stable angina) benefit from ongoing beta-blocker therapy, see Beta blockers to prevent angina.

Patients with reduced left ventricular systolic function (left ventricular ejection fraction 40% or less) should be treated with a beta blocker long term, even if left ventricular dysfunction improvesChew, 2016. Use one of the beta blockers shown to be effective in heart failure with reduced ejection fraction (HFrEF) (bisoprolol, carvedilol, metoprolol succinate or nebivolol)—see Beta blockers for HFrEF for dosage information.

Avoid beta-blocker therapy in patients with chronic limb-threatening ischaemia unless the benefit outweighs the potential harm.