Beta blockers do not benefit all patients

A mega-study led by National Center for Cardiovascular Research (CNIC)in collaboration with other international institutions, concludes that the beta blocker drugs They do not provide any clinical benefit in patients who have normal cardiac function after a heart attack.

This is revealed by this great analysis that has been published in ‘The New England Journal of Medicine‘ and which has included 17,801 patients from 5 studies. The results have been presented at the Congress of the American Heart Association (AHA) in New Orleans (USA).

The study confirms that beta blockers, one of the most widespread treatments after a acute myocardial infarctiondo not reduce the risk of death, new heart attacks or heart failure in those patients whose contractile function of the heart is normal.

Borja Ibanezprincipal investigator of the study and scientific director of the CNIC. explains that this work has analyzed individual data from all contemporary clinical trials – REBOOT in Spain and Italy, REDUCE-AMI in Sweden, BETAMI in Norway, DANBLOCK in Denmark and CAPITAL-RCT in Japan – carried out in patients who had suffered a heart attack, but maintained normal cardiac function (left ventricular ejection fraction (LVEF) = 50%), which indicates that their heart continues to function properly.

In the analysis, half of the participants received beta blockers while the other half did not. After a follow-up of almost 4 years, about 8 percent of patients suffered a major cardiovascular event (such as death, new heart attack or heart failure). This percentage was similar in both groups, both in those who received beta blockers and in those who did not take them.

The researchers also found that there were no benefits when analyzing mortality separately (both total and cardiac origin), new heart attacks, heart failure or serious arrhythmias. The results were similar in all groups of patients, regardless of age, sex or the type of beta blocker they used.

“This shows that there is no subgroup of post-infarction patients with normal cardiac function that benefits from beta blockers”indicated Xavier Rosselló, scientist at the CNIC and cardiologist at the Son Espases Hospital in Mallorca, and co-first signatory of the work.

Beta blockers remain important for other patients

“Although women in this meta-analysis have more adverse events when treated with beta-blockers, something we had already observed in REBOOT, this difference was not relevant enough to reach statistical significance. This may be due to differences in the interaction of beta-blockers with sex in southern Europe versus northern Europe, or to other reasons. In any case, it is reassuring that the possible adverse effect observed in a small group of women does not seem consistent when all the trials are analyzed together,” he explained. Ibanez.

Now, Ibáñez emphasizes that “it is important to highlight that beta blockers They continue to be an essential treatment for other types of patientslike those who have a reduced left ventricular fraction after infarction (<50%) or those who have other pathologies such as chronic heart failure or cardiac arrhythmias“.

He also points out that “these results do not mean that patients have been treated poorly until now, but rather they show that the great improvement in the management of heart attack in recent years means that beta blockers are no longer necessary from this moment on.

It is important to note that the clinical trials that make up this mega-study did not include patients who were already taking beta-blockers for another reason (for example heart failure or arrhythmias), so their conclusions exclusively apply to the use of beta-blockers after the infarction with normal cardiac function.

Paradigm shift

For more than 40 years, all patients who suffered a heart attack were treated with beta blockers for life, regardless of their heart function. This is because clinical trials conducted in the 1970s and 1980s showed a benefit from these drugs.

However, the authors of the study point out that the management of infarction since then has changed radically and the prognosis of patients is much better than then, with them being less likely to have malignant arrhythmias or heart failure.

The REBOOT clinical trial, led by the CNIC, already pointed to a paradigm shift. “This meta-analysis irrefutably confirms what REBOOT already pointed out: patients who have normal cardiac function after a heart attack do not obtain any benefit from being treated with beta-blockers,” they point out.

“In this year 2025 we have modified a paradigm in the treatment of heart attacks that seemed unquestionable for decades. From now on, patients who are discharged after a heart attack with normal cardiac function will no longer receive beta blockers, and this is one of the most important changes in cardiology in recent decades,” he indicated. Valentin Fuster, general director of the CNIC and president of the Mount Sinai Fuster Heart Hospital (USA), and researcher of both REBOOT and this meta-analysis.

At this point, researchers emphasize that it is important not to panic, since beta blockers are very safe drugs with enormous experience in their use. “No one should stop taking these drugs without consulting their doctor,” they add.

“You should consult with a doctor since it may be that you are taking beta blockers for a reason other than a heart attack and that you should continue doing so. The consultation should not be urgent, but rather when the check-up is due. If the doctor confirms that you are taking beta blockers exclusively because you have had a heart attack and the heart function is normal, the beta blocker treatment will surely be withdrawn,” emphasizes Ibáñez.

According to the authors, beta blockers, although with a very high safety profile, are not exempt from possible adverse effects which, although not considered serious, can limit in some way the quality of life of patients. Symptoms such as tiredness, fatigue or sexual dysfunction may appear in some patients on beta-blocker treatment. Therefore, they highlight that the results of this study can have a positive impact on this group of patients.

For researchers, this work will have a major impact on clinical practice guidelines around the world, and as Fuster explains “this study joins others also coordinated by CNIC, such as PESA, SECURE or DapaTAVI that change clinical practice worldwide.”