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Study challenges use of beta-blockers after a heart attack

Researchers found no significant benefit

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Mark Huffman
Reporter

Mark Huffman has covered consumer issues since 2004, with a special focus on protecting and empowering older adults. A former news correspondent for the Associated Press Radio Network, Westwood One, and ConsumerAffairs, Mark brings decades of journalistic experience to RetirementLiving.com. He is passionate about giving consumers a voice and helping them make informed decisions. Mark has also created educational content, including Senior Scam Alert, a video resource designed to help seniors recognize and avoid fraud. He holds a B.A. from the University of Kentucky and lives with his family in Richmond, Virginia.
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Key Insights

  • A large European trial found no significant benefit of beta-blockers after a heart attack in patients with preserved heart function.
  • Outcomes for death, reinfarction, and heart failure hospitalization were similar whether patients received beta-blockers or not.
  • Findings raise questions about long-standing guidelines recommending routine beta-blocker use after myocardial infarction.

A new multinational study is challenging one of cardiology’s most enduring practices: prescribing beta-blockers to nearly all patients following a heart attack. 

The research, conducted in Spain and Italy and published in the New England Journal of Medicine, found that in patients whose heart function remains preserved after a myocardial infarction, beta-blockers did not reduce the risk of death, reinfarction, or hospitalization for heart failure.

Outdated evidence?

For decades, international guidelines have recommended long-term beta-blocker therapy after a heart attack, even when patients have normal heart pumping function. These recommendations stem largely from trials performed in the 1970s and 1980s, an era before modern treatments such as routine reperfusion, invasive coronary care, widespread revascularization, and advanced pharmacologic therapies became standard.

Researchers enrolled 8,438 patients who had suffered an acute myocardial infarction, with or without ST-segment elevation, and who had a left ventricular ejection fraction greater than 40%. Patients were randomly assigned to either beta-blocker therapy or no beta-blocker therapy. They were followed for a median of 3.7 years.

The primary outcome – a composite of all-cause death, recurrent heart attack, or hospitalization for heart failure – occurred at similar rates in both groups. Specifically, 316 patients in the beta-blocker group and 307 in the no-beta-blocker group experienced such events, translating to nearly identical event rates (22.5 vs. 21.7 per 1,000 patient-years). 

Hazard ratios showed no statistical advantage for beta-blockers across individual outcomes as well, including mortality, reinfarction, and heart failure hospitalizations.

Implications: Time to reconsider routine prescriptions?

The results suggest that for patients with preserved heart function, beta-blockers may not provide the protection once assumed. Importantly, safety profiles were similar between groups, indicating that avoiding beta-blockers in this population does not increase risk.

“Among patients discharged after invasive care for a myocardial infarction with a left ventricular ejection fraction above 40%, beta-blocker therapy appeared to have no effect,” the study concluded.