In a large effort coordinated by the Centro Nacional de Investigaciones Cardiovasculares (CNIC) in partnership with international research teams, data from 17,801 myocardial infarction survivors who maintained normal cardiac function were combined. The patients were drawn from five worldwide clinical trials – REBOOT (Spain & Italy), REDUCE‑AMI (Sweden), BETAMI (Norway), DANBLOCK (Denmark), and CAPITAL‑RCT (Japan).
Analysis of individual patient records indicated that beta‑blocker therapy, one of the most frequently prescribed drugs following an acute myocardial infarction, did not lower the risk of death, repeat infarction, or heart failure in those with preserved left‑ventricular ejection fractions above 50 %. This group now represents the majority of post‑infarction survivors.
Half of the cohort received beta‑blockers and the other half did not. Across a median follow-up of nearly four years, approximately 8 % of participants experienced a major cardiovascular event – death, recurrent infarction, or heart failure – and the event rate was essentially identical between the two groups.
Dr. Borja Ibáñez, CNIC Scientific Director and a cardiologist at Hospital Universitario Fundación Jiménez Díaz, led the study. He noted that the analysis showed “no benefit when examining individual outcomes such as overall or cardiac mortality, recurrent infarction, heart failure, or serious arrhythmias. The results were consistent across all patient subgroups, regardless of age, sex, or type of beta‑blocker used.”
Co‑first author Dr. Xavier Rosselló, a CNIC scientist at Hospital Son Espases, emphasized that the meta‑analysis confirms beta‑blockers provide no advantage for any subgroup of post‑infarction patients with preserved cardiac function.
Female patients were of particular interest, as the REBOOT trial had suggested possible harm in women. The pooled analysis found a higher rate of adverse events among women given beta‑blockers, but this difference did not reach statistical significance. CNIC researchers reaffirm their commitment to studying sex‑based differences in cardiovascular disease and treatment responses.
Beta‑blockers remain essential for other populations, such as those with reduced left‑ventricular function after infarction (ejection fraction < 50 %) or individuals with chronic heart failure or arrhythmias. The trials included in this review did not enroll patients already taking beta‑blockers for other indications, so the conclusions apply only to initiating beta‑blocker therapy after infarction in patients with normal heart function.
The REBOOT trial – the largest and strongest of the five – had previously shown no benefit of beta‑blockers in patients with preserved function. A separate analysis combining BETAMI and DANBLOCK suggested a modest reduction in repeat infarction rates, likely due to the inclusion of some patients with slightly reduced function, a group known to benefit from beta‑blockers. The combined meta‑analysis negates that signal, proving beta‑blockers do not confer advantage even for this endpoint.
“Thanks to this collaborative effort, we now have a clear direction: patients with preserved cardiac function do not benefit from beta‑blockers, whereas those with reduced function do,” the investigators conclude.
Since about 70 % of today’s infarction patients have preserved cardiac function, these findings carry global significance. For more than four decades, it was standard practice for all MI survivors to receive lifelong beta‑blockers, based on trials from the 1970s and 1980s. Advances in acute and long‑term care have dramatically improved outcomes, reducing severe arrhythmias and heart failure, and the data support a paradigm shift.
Dr. Valentín Fuster, CNIC Director General and president of the Mount Sinai Fuster Heart Hospital, highlighted that this study overturns a decades‑old treatment standard. “From now on, patients discharged after a heart attack with normal cardiac function will no longer receive beta‑blockers,” he said. “This is one of the most important changes in cardiology in recent years.”
Patients are urged not to stop taking beta‑blockers without a doctor’s advice. “Some patients may be on these medications for reasons other than a heart attack,” Dr. Ibáñez explained. “In those cases, treatment should continue.” The issue is not urgent but can be addressed at routine follow‑up visits, where physicians can confirm whether beta‑blockers are still necessary.
Beta‑blockers generally have a favorable safety profile, but like all drugs they can cause side effects such as fatigue or sexual dysfunction, which can impact quality of life. Eliminating unnecessary prescriptions may improve patient well‑being.
This study is expected to influence clinical guidelines worldwide. As Dr. Fuster noted, it joins other CNIC‑led initiatives—including PESA, SECURE, and DapaTAVI—that are reshaping global cardiac practice.