For decades, beta blockers have been prescribed almost automatically after a heart attack. But new large-scale studies are now questioning whether this long-standing practice is still necessary for every patient.
Beta Blockers: A Standard Treatment Under Review
Beta blockers are widely used medications designed to slow the heart rate and reduce blood pressure. For more than 40 years, they have been a standard part of post-heart attack treatment.
However, cardiology experts now say that advances in medical procedures and newer therapies may have changed the role of beta blockers in modern care.
The REBOOT Trial: No Clear Benefits for Many Patients
A major new study called REBOOT, carried out in Spain and Italy, has cast doubt on the routine use of beta blockers in certain patients.
The trial involved over 8,400 heart attack patients with heart function above 40%.
Patients were randomly assigned either to continue with beta blockers or not take them at all within two weeks of hospital discharge.
After a follow-up of nearly 3.7 years, there was no significant difference between the two groups in terms of:
Death from any cause
Repeat heart attacks
Hospitalisation due to heart failure
The findings, published in the New England Journal of Medicine (NEJM) and presented at the European Society of Cardiology Congress 2025 in Madrid, challenge the long-standing assumption that beta blockers always improve survival after a heart attack.
Gender-Specific Findings Raise Concerns
A subanalysis of the REBOOT trial, focusing on 1,600 women, revealed an even more concerning trend:
Women taking beta blockers had a higher risk of death from all causes compared to women not on the medication.
Men in the trial did not show this increased risk.
Researchers urged caution in interpreting these results, noting that the women included were generally older, had more health complications, and received less treatment for their heart attacks compared to men.
(Source: European Heart Journal)
The BETAMI-DANBLOCK Trial: Different Results
A second study, called BETAMI-DANBLOCK, also published in NEJM, provided a slightly different perspective:
This trial involved more than 5,000 patients with either mildly reduced or normal heart function after a heart attack.
Over 3.5 years, patients who took beta blockers experienced fewer new heart attacks compared to those who did not.
However, there was no difference between groups when it came to:
Overall death rates
Stroke
Heart failure
Other major cardiac complications
Dr Gregg Fonarow, professor of cardiovascular medicine at UCLA, explained to ABC News that the key finding was mainly a reduction in non-fatal heart attacks.
Still, experts noted the trial had limitations, as it combined two smaller studies with different patient criteria, which could affect the reliability of the results.
Experts Call for a Re-Evaluation of Guidelines
Cardiologists stress that while beta blockers were once life-saving, today’s medical landscape looks very different:
Modern treatments such as coronary stents, improved blood-thinning medications, and faster emergency interventions have drastically reduced heart attack risks.
Beta blockers were originally developed in an era before routine reperfusion therapies (such as reopening blocked arteries quickly) became standard practice.
Dr Steven Pfau of Yale School of Medicine commented:
“If beta blockers do have an effect, it is probably small, given the other therapies we have today.”
What This Means for Patients
Experts caution patients not to stop taking beta blockers without medical advice.
According to Dr Fonarow, patients who tolerate the medication well should continue until more research identifies exactly who benefits most.
Both REBOOT and BETAMI-DANBLOCK highlight that beta blockers may not be necessary for every heart attack patient, especially those with preserved heart function.
Future studies are needed to determine which patients still gain the most from these drugs in the modern era of advanced cardiac care.
Conclusion
The findings from REBOOT and BETAMI-DANBLOCK have sparked an important debate in the cardiology community. After four decades of routine use, beta blockers may no longer be the universal answer for heart attack patients—particularly those with normal heart function.
Instead, personalised treatment, based on a patient’s individual risk factors, age, gender, and overall health, may be the way forward.
For now, cardiologists urge patients to consult their doctors before making any changes to prescribed medication.
Sources:
New England Journal of Medicine (2025)
European Heart Journal (2025)
European Society of Cardiology Congress, Madrid
ABC News interview with Dr Gregg Fonarow
Comments from Dr Steven Pfau, Yale School of Medicine
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