Overview

• REBOOT, a randomized trial of 8,505 patients in Spain and Italy with post–myocardial infarction ejection fraction above 40%, found no difference in death, recurrent heart attack, or heart-failure hospitalization between beta-blocker therapy and no beta-blocker over nearly four years.
• A prespecified REBOOT analysis reported that women with normal ejection fraction (50% or higher) had higher rates of death, reinfarction, or heart-failure hospitalization on beta-blockers, including a 2.7% higher absolute mortality, while men showed no excess risk.
• Investigators noted that women in the trial were older, had more comorbidities, and received some secondary-prevention therapies less often, factors that warrant cautious interpretation of the sex-specific findings.
• The BETAMI–DANBLOCK trial of about 5,500 patients in Norway and Denmark found fewer nonfatal repeat heart attacks with beta-blockers but no reduction in death or heart failure, highlighting differences across contemporary studies.
• A pooled analysis reported in The Lancet indicated a clear benefit for patients with mildly reduced ejection fraction (40–49%), supporting EF-based prescribing as experts and guideline groups evaluate practice changes.