Beta blockers after heart attack: A large randomised study from Spain and Italy has found that routinely prescribing beta blockers to heart-attack survivors whose heart function is intact does not clearly improve outcomes.
The REBOOT trial, published in the New England Journal of Medicine and presented at the European Society of Cardiology Congress 2025 in Madrid, challenges decades of standard practice.
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Researchers enrolled more than 8,400 patients after a heart attack with left-ventricular ejection fraction above 40%. Within two weeks of discharge, participants were assigned to either start a beta blocker or no beta blocker. Over a median 3.7-year follow-up, there was no significant difference between groups in all-cause death, recurrent heart attack, or hospitalisation for heart failure.
A prespecified analysis of ~1,600 women from the trial, reported in the European Heart Journal, found an association between beta-blocker use and higher all-cause mortality among women compared with those not taking the drugs; no excess risk was seen in men. The authors cautioned that the women in REBOOT were generally older, had more illness, and received less intensive heart-attack treatment than men, so the finding should be interpreted carefully.
Separate results from another trial, BETAMI-DANBLOCK, also published in NEJM, suggested beta blockers may lower the risk of non-fatal repeat heart attacks over about 3.5 years in more than 5,000 patients with mildly reduced or preserved heart function, but without reducing death, heart failure, stroke, or other major events. Experts noted that BETAMI-DANBLOCK combined two smaller trials with differing eligibility rules, which may limit how broadly its findings apply.
Taken together, the studies suggest any benefit of routine beta-blocker therapy after a heart attack may be modest for patients with preserved heart function, especially in the modern era of rapid artery-opening procedures and improved medications.
(Source: New England Journal of Medicine)
