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14h ago

Major Trials Upend Routine Beta‑Blocker Use After Heart Attack With Preserved Ejection Fraction

Presented at ESC with simultaneous NEJM publication, the findings highlight uncertainty for patients with fully preserved function.

Overhead view of senior Asian woman feeling sick, taking medicines in hand with a glass of water at home. Elderly and healthcare concept
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Overview

  • REBOOT, a randomized trial of 8,505 patients in Spain and Italy with post‑MI ejection fraction ≥40%, found no difference in death, recurrent MI, or heart‑failure hospitalization between beta‑blocker therapy and no beta‑blocker over nearly four years.
  • A prespecified REBOOT analysis reported higher risk for women with ejection fraction ≥50% on beta‑blockers, including a 2.7% absolute increase in mortality over 3.7 years, while men showed no clear benefit or harm.
  • BETAMI–DANBLOCK, enrolling roughly 5,500 patients in Norway and Denmark, found fewer nonfatal recurrent heart attacks with beta‑blockers but no reduction in mortality or other major outcomes.
  • Pooled and secondary analyses indicate benefit for patients with mildly reduced ejection fraction (40–49%), reinforcing EF‑stratified effects and leaving uncertainty for those with completely preserved function.
  • Investigators and experts are urging reassessment of post‑MI beta‑blocker guidance with attention to sex‑specific prescribing and dosing, while cautioning that differences between trials warrant further analysis before sweeping changes.