β-blockers for the post-myocardial infarction patient:: Current clinical evidence and practical considerations

beta-Blockers significantly decrease the risk of mortality in patients after myocardial infarction (MI). Furthermore, beta-blockers reduce the risk of reinfarction and mortality in both the immediate and long term after an MI. Guidelines recommend that post-MI patients should be started on beta-blocker therapy and continued indefinitely, unless absolutely contraindicated or not tolerated. Despite compelling evidence, many patients are not prescribed beta-blockers after a myocardial event. In addition, some patients are treated with agents whose long-term use has not been shown to be effective. This article discusses practical implementation of beta-blockers, provides the rationale for choosing specific beta-blockers, and presents protocols for initiating or switching to evidence-based therapies in the acute and chronic post-MI period.