A major study is set to ‘reshape clinical guidelines’ after finding there is no clinical benefit to treating patients who have had a heart attack with beta blockers.
The findings show that this common drug, which has been the standard treatment for heart attack for 40 years, provides no benefit for people who have suffered an uncomplicated myocardial infarction (heart attack) with preserved heart function.
In fact, women treated with beta blockers were found to have a higher risk of death, heart attack, or hospital admission for heart failure compared to women not taking the medication. This increased risk was not seen in men.
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The team behind the study say that while new drugs are often tested, older treatments are less rigorously tested.
The REBOOT trial is the largest clinical trial on the subject of beta blockers being used to treat heart attack, with researchers enrolling 8,505 patients across 109 hospitals in Spain and Italy.
Participants randomly received or didn’t receive beta blockers after leaving hospital and were followed for a median of nearly four years.
The results showed no significant differences between the two groups in rates of death, recurrent heart attack, or hospital admission for heart failure.
Principal Investigator Borja Ibáñez said: “REBOOT will change clinical practice worldwide. Currently, more than 80% of patients with uncomplicated myocardial infarction are discharged on beta blockers.
“The REBOOT findings represent one of the most significant advances in heart attack treatment in decades.”
Further analysis found that women treated with beta blockers had a 2.7% higher absolute risk of mortality compared to those not treated with beta-blockers. This increased risk was restricted to women with a complete normal cardiac function after a heart attack.
Dr. Ibáñez said: “After a heart attack, patients are typically prescribed multiple medications, which can make adherence difficult. Beta blockers were added to standard treatment early on because they significantly reduced mortality at the time. Their benefits were linked to reduced cardiac oxygen demand and arrhythmia prevention.
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“But therapies have evolved. Today, occluded coronary arteries are reopened rapidly and systematically, drastically lowering the risk of serious complications such as arrhythmias. In this new context—where the extent of heart damage is smaller—the need for beta blockers is unclear. While we often test new drugs, it’s much less common to rigorously question the continued need for older treatments.
“The trial was designed to optimise heart attack care based on solid scientific evidence and without commercial interests. These results will help streamline treatment, reduce side effects, and improve quality of life for thousands of patients every year.”
