Recommendation 29: We recommend NYHA class IV patients be stabilized before initiation of a beta-blocker (Strong Recommendation, High Quality Evidence).

Recommendation 30: We recommend that beta-blockers be initiated as soon as possible after diagnosis of heart failure, including during the index hospitalization, provided that the patient is hemodynamically stable. Clinicians should not wait until hospital discharge to start a beta-blocker in stabilized patients (Strong Recommendation, High Quality Evidence).

Recommendation 31: We recommend that beta-blockers be initiated in all patients with an LVEF < 40% with prior myocardial infarction (Strong recommendation, Moderate Quality Evidence).