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1h ago

Trials Recast Beta-Blocker Use After Heart Attack, Flag Risk for Some Women With Preserved EF

Clinicians are urged to reevaluate routine prescribing in light of contemporary evidence from modern cardiac care.

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Overview

  • The REBOOT randomized trial of 8,505 post–myocardial infarction patients with ejection fraction above 40% found no reduction in death, recurrent heart attack, or heart-failure hospitalization with beta-blockers over roughly four years.
  • A prespecified REBOOT analysis reported higher rates of death, reinfarction, or heart-failure hospitalization in women given beta-blockers, with excess risk confined to those with ejection fraction at least 50% and an absolute mortality increase of 2.7%.
  • Investigators noted that women in the cohort were older, had more comorbidities and non‑obstructive infarctions, and were less often prescribed some guideline secondary‑prevention therapies.
  • The BETAMI‑DANBLOCK pooled trial showed fewer non‑fatal recurrent heart attacks with beta‑blockers but no difference in mortality, heart failure, stroke, or other major outcomes.
  • Experts recommend cautious, individualized prescribing and further study rather than automatic use, with advice not to make abrupt changes for patients already tolerating therapy.