For decades, beta blockers have been routinely prescribed after heart attacks, especially as part of standard recovery care. But new evidence from the 2025 REBOOT Trial suggests the drugs may offer little benefit for many patients who have an uncomplicated myocardial infarction and retain normal heart pumping function.
Presented at the European Society of Cardiology Congress in Madrid and published in The New England Journal of Medicine, REBOOT enrolled 8,505 patients at 109 hospitals in Spain and Italy. Participants were randomly assigned after discharge either to receive beta blockers or to avoid them, while continuing other contemporary heart attack treatments. Researchers followed patients for a median of nearly four years.
The study found no significant reduction in death, repeat heart attack, or hospitalization for heart failure among patients with preserved heart function who took beta blockers. The finding challenges a practice that developed decades ago, before rapid artery reopening, statins, antiplatelet medicines, and other modern therapies became common.
Investigators said the results could affect prescribing patterns, since more than 80 percent of patients with uncomplicated heart attacks are reportedly discharged on beta blockers. The drugs are generally considered safe but can cause fatigue, low heart rate, and sexual dysfunction, adding to the medication burden many patients face after hospitalization.
A related REBOOT substudy reported a higher risk of adverse outcomes among women taking beta blockers, particularly those whose heart function was fully normal. This signal was not seen in men, and researchers said it supports more individualized decision-making. They also emphasized that patients should not stop prescribed medicines without consulting a clinician.
Other recent trials have reached similar or more mixed conclusions. REDUCE-AMI found no clear benefit in patients with preserved function, while pooled analyses suggest patients with mildly reduced function may still benefit. The evidence points toward selective use.