From the Publishers of
Balancing the Medication
Portfolio 5 Years after a Heart
Attack
COPYRIGHT © 2014, ALL RIGHTS RESERVED
Terms of Use
The Consult Guys® slide sets are owned and copyrighted by the American College
of Physicians (ACP). All text, graphics, trademarks, and other intellectual property
incorporated into the slide sets remain the sole and exclusive property of ACP.
The slide sets may be used only by the person who downloads or purchases them
and only for the purpose of presenting them during not-for-profit educational
activities. Users may incorporate the entire slide set or selected individual slides
into their own teaching presentations but may not alter the content of the slides in
any way or remove the ACP copyright notice.
Users may make print copies for use as hand-outs for the audience the user is
personally addressing but may not otherwise reproduce or distribute the slides by
any means or media, including but not limited to sending them as e-mail
attachments, posting them on Internet or Intranet sites, publishing them in meeting
proceedings, or making them available for sale or distribution in any unauthorized
form, without the express written permission of the ACP. Unauthorized use of the
Consult Guys® slide sets constitutes copyright infringement.
Copyright © 2014
Copyright © 2014
Copyright © 2014
Copyright © 2014
Joe
 61 years old
 DMI 5 years ago
 Small RCA, no other CAD
 No revascularization
 LVEF 48% (reassessed 1 year ago)
 Family history of CAD (father age 51)
 History hyperlipidemia treated
Copyright © 2014
Joe
Medications
(initiated 5 years ago post MI evaluation)
 Aspirin 325 mg daily
 Clopidogrel 75 mg daily
 Metoprolol 50 mg twice daily
 Enalapril 10 mg daily
 Statin
Copyright © 2014
Copyright © 2014
Recommendations
 Recommendation 17: The organizations recommend that
aspirin, 75 to 162 mg daily, should be continued indefinitely
in the absence of contraindications in patients with stable
IHD
*Grade: strong recommendation; high-quality evidence.
Copyright © 2014
Medications
Medications initiated 5 years ago at time of post MI eval:
Aspirin 325 mg daily 81-162 mg daily
Clopidogrel 75 mg daily
Metoprolol 50 mg twice daily
Enalapril 10 mg daily
Statin
Copyright © 2014
Medications
Medications initiated 5 years ago at time of post MI eval:
Aspirin 325 mg daily 81-162 mg daily
Clopidogrel 75 mg daily
Metoprolol 50 mg twice daily
Enalapril 10 mg daily
Statin
Copyright © 2014
Freemantle N, Cleland J, Young P, Mason J, Harrison J. β Blockade after myocardial
infarction: systematic review and meta regression analysis. BMJ : British Medical Journal
1999; 318:1730-1737.
• Mean follow up only 1.4 years
• Median publication date of the 82
trials:1982
• Most trials before modern reperfusion
therapy
• Most trials before current medical
therapy
Medications
Medications initiated 5 years ago at time of post MI eval:
Aspirin 325 mg daily 81-162 mg daily
Clopidogrel 75 mg daily
Metoprolol 50 mg twice daily
Enalapril 10 mg daily
Statin
Copyright © 2014
Recommendations
 Recommendation 20:The organizations recommend that
beta blocker therapy should be initiated and continued for 3
years in all patients with normal LV function following MI or
acute coronary syndromes
*Grade: strong recommendation; moderate-quality evidence.
 Recommendation 21: The organizations recommend that
metoprolol succinate, carvedilol, or bisoprolol should be
used for all patients with systolic LV dysfunction (ejection
fraction <40%) with heart failure or prior MI, unless
contraindicated
*Grade: strong recommendation; high-quality evidence.
Copyright © 2014
Recommendations
 Recommendation 22: The organizations recommend that
ACE inhibitors should be prescribed in all patients with
stable IHD who also have hypertension, diabetes, LV
systolic dysfunction (ejection fraction <40%), and/or chronic
kidney disease, unless contraindicated
*Grade: strong recommendation; high-quality evidence.
Copyright © 2014
Medications
Medications initiated 5 years ago at time of post MI eval:
Aspirin 325 mg daily 81-162 mg daily
Clopidogrel 75 mg daily
Metoprolol 50 mg twice daily
Enalapril 10 mg daily
Statin
Copyright © 2014
Produced by
and
Copyright © 2014
COPYRIGHT © 2014, ALL RIGHTS RESERVED