For decades, beta-blockers have been a standard treatment for people recovering from a heart attack.
But new research suggests that most patients with normal heart function after a heart attack may not need them at all.
A major international analysis led by the Centro Nacional de Investigaciones Cardiovasculares (CNIC) in Spain, and published in The New England Journal of Medicine, has found that beta-blockers do not provide any additional benefit to this growing group of patients.
The large meta-analysis combined data from five major clinical trials involving 17,801 heart attack survivors with normal heart function—defined as a left ventricular ejection fraction (LVEF) of 50% or higher.
These trials included REBOOT (Spain and Italy), REDUCE-AMI (Sweden), BETAMI (Norway), DANBLOCK (Denmark), and CAPITAL-RCT (Japan). About half of the participants received beta-blockers after their heart attack, while the other half did not.
After almost four years of follow-up, researchers found no meaningful differences between the two groups. Around 8% of participants experienced a major heart-related event, such as death, another heart attack, or heart failure—and this rate was nearly identical regardless of whether they took beta-blockers.
The findings were also consistent across all subgroups, including age, gender, and the specific type of beta-blocker used.
Dr. Borja Ibáñez, the study’s lead investigator and Scientific Director at CNIC, said the results were clear: “We found no evidence that beta-blockers reduce the risk of death, repeat heart attacks, heart failure, or dangerous heart rhythms in patients with preserved cardiac function.”
Co-author Dr. Xavier Rosselló added, “This shows that beta-blockers simply don’t benefit this group of post-heart attack patients.”
Interestingly, the study also examined potential sex differences. Earlier results from one of the included trials, REBOOT, suggested beta-blockers might even be harmful for women. In the new pooled analysis, women did appear to experience more side effects from beta-blockers, but the difference was not statistically significant.
The researchers emphasized that more research is needed to fully understand how treatments affect men and women differently.
While this finding may surprise many doctors, the researchers stressed that beta-blockers remain very important for other groups—especially those with reduced heart function (LVEF below 50%), chronic heart failure, or irregular heart rhythms.
“These drugs are still lifesaving for many patients,” Dr. Ibáñez said. “But for people whose heart function has recovered after a heart attack, they don’t appear to make a difference.”
This conclusion marks a major turning point in cardiology. For more than 40 years, all heart attack survivors were routinely prescribed beta-blockers for life. This recommendation was based on studies from the 1970s and 1980s, when heart attack care was far less advanced and complications were more common.
Modern treatments—such as stents, blood thinners, and improved emergency care—have dramatically reduced the risks of arrhythmias and heart failure. As a result, the old rationale for lifelong beta-blocker use no longer applies to most patients today.
Dr. Valentín Fuster, General Director of CNIC and President of the Mount Sinai Fuster Heart Hospital, described the results as “a paradigm shift.” He said, “In 2025, we have overturned a treatment practice that went unquestioned for decades.
From now on, patients discharged after a heart attack with normal heart function will no longer need beta-blockers. This is one of the most significant changes in cardiology in recent years.”
The researchers also emphasized that patients currently taking beta-blockers should not stop their medication on their own. “Anyone taking beta-blockers should talk to their doctor first,” Dr. Ibáñez advised.
“If you’re taking them for another condition, like heart failure or arrhythmia, they remain essential. But if you’re taking them only because of a past heart attack and your heart function is normal, your doctor may decide to discontinue them safely.”
Although beta-blockers are generally safe, they can cause side effects such as fatigue or sexual dysfunction. For many patients, this new research could improve both their quality of life and their treatment experience by avoiding unnecessary medications.
The findings are expected to have an immediate impact on international clinical guidelines for managing heart attack survivors.
This study underscores how advances in medicine continuously refine our understanding of disease and treatment. As Dr. Fuster noted, “Our findings are helping to modernize global heart care, ensuring that patients receive treatments that truly benefit them.”
If you care about heart health, please read studies about how eating eggs can help reduce heart disease risk, and herbal supplements could harm your heart rhythm.
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The study is published in New England Journal of Medicine.
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