Beta-blockers show no benefit after myocardial infarction

Original reference:
Borja Ibáñez et al. “Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction”, The New England Journal of Medicine, 2025.

Why does this matter?

Beta-blockers are among the most widely known and prescribed medications for cardiovascular disease.
Millions of people worldwide take them after suffering a myocardial infarction (heart attack).

Their primary function is to reduce heart rate and blood pressure, thereby decreasing the workload on the heart.

For decades, it was believed that all people who had experienced a heart attack should take them “as a precaution”, to reduce the risk of death or a further infarction.

But a major new Spanish study has called that practice into question.

The REBOOT study, led by Dr Borja Ibáñez of the Centro Nacional de Investigaciones Cardiovasculares (CNIC, Madrid), is the largest clinical trial of recent decades on this topic.

🔹 8,438 patients from 45 hospitals in Spain and Italy participated.
🔹 All had recently suffered a myocardial infarction.
🔹 Crucially: their cardiac function was normal or near-normal, with an ejection fraction above 40%.

The researchers divided patients into two groups:

one received beta-blockers (mainly metoprolol or bisoprolol),
and the other did not.

Follow-up was conducted over nearly four years (mean 3.7 years).

Study results

The results surprised even the investigators themselves:

“In patients with myocardial infarction and preserved cardiac function, beta-blockers do not reduce the risk of death, reinfarction, or hospitalisation for heart failure.”
— Borja Ibáñez et al., NEJM, 2025

📉 Complication rates were virtually identical:

7.9% in the beta-blocker group,
8.3% in the untreated group.

The difference is not significant (p = 0.63).

Furthermore, side effects — such as fatigue, low blood pressure, or an excessively slow heart rate — were more frequent among those taking beta-blockers.

What this means for patients

The conclusion of REBOOT is clear:

“If the heart is functioning well after a heart attack, there is no benefit in continuing to take beta-blockers routinely.”

This does not mean that beta-blockers are “bad” or that they should be discontinued.
For many patients — particularly those with heart failure, arrhythmias, or chest pain — they remain essential medications.

But the study demonstrates that the same prescription can no longer be applied to everyone.
Treatment must be individualised, adapted to each specific case.

🚻 A noteworthy finding: the effect was even less favourable in women

Although this was not the primary objective of the study, the investigators noted an interesting detail:
among women taking beta-blockers, there were more adverse effects and poorer tolerability of the treatment.

As a result, several Spanish cardiologists are now proposing further investigation into whether hormonal or physiological differences may influence the response to these drugs.

🧠 Why were they prescribed to everyone before?

When beta-blockers first appeared in the 1970s, they did demonstrate substantial benefit.
But at that time, patients did not receive stents, statins, or other modern treatments.

Today, medicine has advanced considerably. What was essential 40 years ago may no longer offer advantages in the present day.

🇪🇺 Response in Spain and Europe

Following publication of the study, the Spanish Society of Cardiology (SEC) and the European Society of Cardiology (ESC) announced that the REBOOT results will be incorporated into forthcoming clinical guidelines.

In the meantime, experts recommend:

not discontinuing treatment independently,

consulting a cardiologist,

and reviewing the therapeutic plan according to each patient’s individual situation.

📢 Statements from the principal investigator

Dr Borja Ibáñez (CNIC) explained in an interview with El País:

“This is not an attack on beta-blockers.
It is a step towards more precise and personalised medicine.
Not all patients are the same, and not all patients need the same drugs.”

💬 What to do if you are taking beta-blockers

If you have had a heart attack and are taking beta-blockers, do not be alarmed or stop your medication.
The best course of action is:

📅 Make an appointment with your cardiologist.
🩺 Ask them what your ejection fraction is and whether you genuinely need to continue treatment.
💬 Mention any adverse effects (fatigue, low blood pressure, slow pulse).

Spanish research is leading the advancement of cardiovascular medicine worldwide. If you want to train within the healthcare system that produces these landmark studies, discover our medical internships in hospitals in Spain and learn from the best European specialists.