A groundbreaking meta-analysis is challenging long-held beliefs about treating heart attack patients. It’s time to rethink how we approach post-MI care, particularly regarding beta-blockers. For years, these drugs have been a cornerstone of treatment, but new research suggests they may not be beneficial for everyone. This study could change the way guidelines are written and how doctors treat patients. But here’s where it gets controversial: Are we ready to rewrite the playbook on post-heart attack care?
The study, published in the New England Journal of Medicine and presented at the 2025 American Heart Association Scientific Sessions, examined data from nearly 18,000 patients who had experienced a heart attack and had a preserved left ventricular ejection fraction (LVEF ≥ 50%). The goal? To see if beta-blockers improved outcomes. The trials included in the meta-analysis were REBOOT, BETAMI-DANBLOCK, REDUCE-AMI, and CAPITAL-RCT. Senior author Dr. Borja Ibáñez from Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain, called this the “final word” in a field often filled with conflicting data.
The results were clear: beta-blockers did not reduce the risk of death, another heart attack, or heart failure over a median follow-up of 3.6 years compared to no beta-blockers (8.1% vs 8.3%; HR 0.97; 95% CI 0.87-1.07). This is a big deal because current guidelines in the US and Europe recommend beta-blockers for almost all patients after an acute coronary syndrome (ACS), regardless of their LVEF. These recommendations are based on older data, often from studies conducted before modern treatments like PCI with DES and advanced medical therapies.
Dr. Ibáñez believes this study is the “final nail in the coffin” for the routine use of beta-blockers in this specific patient group, and he anticipates that future guidelines will reflect these findings. Dr. Sripal Bangalore of NYU Langone Health agrees, emphasizing that treatments and the types of heart attacks we see today are different from those in the past, so we must constantly reevaluate existing therapies.
The meta-analysis, led by Dr. Anna Meta Dyrvig Kristensen of Copenhagen University Hospital, Denmark, looked at individual patient data from 17,801 patients. The average age was 62 years, and 20.7% were female. The incidence rate of the primary endpoint overall was 2.41 per 100 person-years. The study found no significant differences between the beta-blocker and no-beta-blocker groups in terms of all-cause death, another heart attack, or heart failure. Even after excluding the REDUCE-AMI trial (HR 0.97; 95% CI 0.86-1.10), the results remained consistent.
One trial, BETAMI-DANBLOCK, suggested a potential benefit for patients with an LVEF between 40-49%. However, the meta-analysis concluded that the cutoff should be set at an LVEF of at least 50%.
Dr. Ibáñez predicts an “immediate uptake worldwide,” with doctors potentially avoiding prescribing beta-blockers to post-MI patients with preserved EF. He also suggests that patients currently taking beta-blockers for hypertension, who have had a previous heart attack, might be switched to ACE inhibitors or ARBs, which have shown stronger benefits. However, he stresses the importance of patients consulting their doctors before stopping beta-blockers, as they are still beneficial for other populations, such as those with a low ejection fraction or atrial fibrillation.
But here’s a potential counterpoint: Dr. Johanne Silvain of Sorbonne Université, Paris, France, cautions against oversimplifying the message. She points out that some patients still benefit from beta-blockers after a heart attack, particularly those with larger infarcts, mild LV dysfunction, incomplete revascularization, or concomitant hypertension. Discontinuation in these subgroups could be harmful. The message, she suggests, should be to consider withdrawal only when the residual ischemic and arrhythmic risk is truly minimal.
What do you think? Are you surprised by these findings? Do you think this will change how doctors treat heart attack patients? Share your thoughts in the comments below!