Breakthrough Findings on Beta Blockers Shake Up Post-Heart Attack Care

Madrid, August 31, 2025 - Two landmark studies presented at the European Society of Cardiology Congress and published in leading medical journals have called into question the routine use of beta blockers after myocardial infarction, particularly for patients with preserved heart function.

In the international REBOOT trial-enrolling 8,505 patients across 109 centers in Spain and Italy-continuing beta blocker therapy did not reduce death, recurrent heart attack, or heart failure hospitalization in individuals whose left ventricular ejection fraction exceeded 40 percent. Over a median follow-up of 3.7 years, outcomes were statistically equivalent between treated and untreated groups, prompting recommendations to reconsider decades-old guidelines.

A sex-specific subanalysis revealed that women discharged on beta blockers faced a 2.7 percent higher absolute risk of adverse events, including mortality and repeat infarction, compared to untreated women. No such excess risk emerged in male participants, underscoring potential sex-based differences in drug effects and the need for personalized post-infarct regimens.

Concurrently, the BETAMI-DANBLOCK trial of over 5,000 adults found that beta blocker therapy yielded fewer nonfatal repeat heart attacks but did not affect overall mortality or heart failure rates. While suggesting a modest benefit in reducing subsequent infarctions, experts caution that this smaller trial’s design limitations warrant further research before restoring beta blockers to standard care.

Cardiology leaders anticipate that these findings will drive revisions to international treatment guidelines, balancing the drugs’ historical benefits against modern reperfusion advances and side-effect burdens such as fatigue, bradycardia, and sexual dysfunction. As therapeutic paradigms evolve, clinicians are urged to tailor post-MI medication strategies to individual patient profiles rather than defaulting to blanket beta blocker use.