Indications for neurohormonal blockade and implantable cardioverter-defibrillator use in patients with left ventricular systolic dysfunction without heart failure*

LVEF: left ventricular ejection fraction; ACE: angiotensin converting enzyme; ARB: angiotensin II receptor blocker; MI: myocardial infarction; VT: ventricular tachycardia; VF: ventricular fibrillation; ICD: implantable cardioverter-defibrillator.
* Left ventricular systolic dysfunction is defined here to include globally or focally depressed left ventricular systolic function with or without depressed LVEF. Refer to UpToDate content on diagnosis of asymptomatic left ventricular systolic dysfunction.
¶ Evidence of prior MI includes a prior documented event and/or test findings diagnostic of prior MI. Refer to UpToDate content on diagnosis of myocardial infarction.
Δ For patients with an indication for ACE inhibitor who have a cough caused by ACE inhibitor or angioedema, an ARB is suggested as an alternative.
◊ The recommendation for ACE inhibitor post-MI is strong in patients with LVEF ≤40%, diabetes mellitus, or stable chronic kidney disease and weak for patients without these risk factors.
§ Refer to UpToDate content on the diagnosis and management of heart failure.