Beta blockers ‘have no effect’ on heart attack patients
Beta blockers may provide no clinical value for a majority of heart attack patients, according to new data presented at ESC Congress 2025, the annual meeting of the European Society of Cardiology.
The team’s analysis was simultaneously published in The New England Journal of Medicine.[1]
The REBOOT trial included data from more than 8,500 patients who received treatment in Spain or Italy from 2018 to 2024. All patients presented with a type 1 or type 2 myocardial infarction and a left ventricular ejection fraction of more than 40% before discharge. Patients were randomized to either receive beta-blocker therapy or not receive beta-blocker therapy.
For the patients given beta-blockers, the type and dose of beta-blocker were determined by the managing physician. The randomization was performed at the time of hospital discharge or within 14 days of discharge, and treatment began at the time of randomization. Follow-up occurred after three months, 15 months, 36 months and 48 months.
Overall, after a median follow-up period of 3.7 years, the study’s primary outcome—a composite of all-cause mortality, reinfarction or hospitalization for heart failure—occurred in 316 patients in the beta-blocker group and 307 patients in the no-beta-blocker group. This was the equivalent of 22.5 events and 21.7 events per 1,000 patient-years, respectively, highlighting the fact that beta-blockers “appears to have no effect” on the primary outcome.
Safety outcomes were also comparable between the two groups.
“REBOOT will change clinical practice worldwide,” principal investigator Borja Ibáñez, MD, scientific director of Spain’s Centro Nacional de Investigaciones Cardiovasculares, said in a statement. “Currently, more than 80% of patients with uncomplicated myocardial infarction are discharged on beta blockers. The REBOOT findings represent one of the most significant advances in heart attack treatment in decades.”
Ibáñez emphasized that “therapies have evolved” since beta-blockers became a standard part of care for many heart attack patients.
“Today, occluded coronary arteries are reopened rapidly and systematically, drastically lowering the risk of serious complications such as arrhythmias,” he said. “In this new context—where the extent of heart damage is smaller—the need for beta blockers is unclear. While we often test new drugs, it's much less common to rigorously question the continued need for older treatments.”
Read the team's full analysis here.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.