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12h ago

Major Trial Questions Routine Beta-Blockers After Heart Attack, Flags Risk in Some Women

Specialists are refocusing prescribing by ejection fraction with attention to sex-specific risk.

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Overview

  • REBOOT, a randomized trial of 8,505 patients across 109 hospitals in Spain and Italy, found no overall reduction in death, recurrent myocardial infarction, or heart-failure hospitalization with beta-blockers after uncomplicated heart attack over nearly four years.
  • A prespecified analysis reported that women with fully preserved ejection fraction (≥50%) had worse outcomes on beta-blockers, including a 2.7% higher absolute mortality risk, while men showed no excess risk and women with mildly reduced function did not show harm.
  • A separate Scandinavian study, BETAMI–DANBLOCK, observed fewer nonfatal recurrent heart attacks with beta-blockers but no mortality benefit, highlighting differences between contemporary trials.
  • A pooled analysis reported in The Lancet supports benefit for patients with mildly reduced ejection fraction (about 40–49%), with roughly a 25% reduction in the composite of death, recurrent heart attack, or heart failure.
  • Investigators say the evidence supports moving away from one-size-fits-all treatment toward ejection-fraction– and sex-tailored use, with guideline reviews anticipated; REBOOT was conducted without pharmaceutical industry funding.