Overview

• In the multicenter REBOOT randomized trial of 8,505 post–myocardial infarction patients with left ventricular ejection fraction above 40%, long‑term beta‑blockers did not reduce death, recurrent heart attack, or heart‑failure hospitalization over a median 3.7–4 years.
• A prespecified sex analysis reported higher adverse events in women on beta‑blockers, driven largely by mortality and concentrated in those with ejection fraction of 50% or higher and at higher doses, while men saw no significant difference.
• Contemporary randomized data from Scandinavia reported fewer nonfatal recurrent heart attacks with beta‑blockers without a mortality benefit, with signals of potential benefit in patients with mildly reduced ejection fraction (40–49%).
• Investigators plan a joint meta‑analysis of randomized datasets ahead of the American Heart Association meeting to reconcile mixed findings and inform ejection‑fraction‑ and sex‑specific guidance.
• Experts stress that beta‑blockers remain indicated for reduced ejection fraction and other conditions, and patients should not stop prescribed therapy without medical advice given trial limitations and pending guideline updates.