For more than 40 years, beta blockers have been a routine prescription for people recovering from heart attacks.
These drugs, which slow the heart and reduce its workload, were once lifesaving when treatments for heart attacks were limited.
But new evidence from the largest clinical trial of its kind suggests that beta blockers may offer no benefit for many patients today—and could even be harmful for women.
The findings come from the REBOOT trial, an international study led by the Centro Nacional de Investigaciones Cardiovasculares (CNIC) in Spain, with collaboration from the Mario Negri Institute in Italy.
The results were presented at the European Society of Cardiology Congress in Madrid and published in both The New England Journal of Medicine and the European Heart Journal.
The trial enrolled 8,505 patients across 109 hospitals in Spain and Italy.
All participants had suffered a heart attack but did not have significant damage to their heart’s pumping ability, known as left ventricular ejection fraction.
Patients were randomly assigned to either receive beta blockers or no beta blockers after leaving the hospital. Everyone received standard modern therapies, including rapid reopening of blocked arteries and other guideline-based treatments.
After nearly four years of follow-up, the results were clear: beta blockers made no difference. Rates of death, repeat heart attacks, or hospitalizations for heart failure were nearly identical in patients who received beta blockers and those who did not.
Even more concerning, a detailed analysis showed that women may fare worse on beta blockers. Women with completely normal heart function after a heart attack had a 2.7% higher risk of death compared with those who did not take the drugs.
This excess risk was not seen in women with mild heart impairment, and men showed no such increased risk at all.
Dr. Borja Ibáñez, Scientific Director at CNIC and lead presenter of the results, emphasized the importance of the findings.
“More than 80% of patients with uncomplicated heart attacks are discharged on beta blockers. These results suggest that this may not only be unnecessary, but in the case of some women, potentially harmful,” he explained.
Beta blockers can also cause side effects such as fatigue, low heart rate, and sexual dysfunction, which can make long-term adherence challenging. Historically, the drugs reduced deaths by lowering oxygen demand and preventing dangerous arrhythmias.
But with modern treatments that quickly restore blood flow and limit heart damage, their benefit now appears much smaller.
Professor Valentin Fuster, President of Mount Sinai Fuster Heart Hospital and senior investigator of REBOOT, said the study could reshape global treatment guidelines. “This is one of the most significant advances in heart attack care in decades,” he noted.
By questioning an old standard of care, REBOOT highlights the need to update treatments based on today’s medical realities. For many patients—and particularly for women—rethinking the use of beta blockers may lead to safer, simpler, and more effective recovery after a heart attack.
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Source: KSR.
