A groundbreaking international study has found that beta blockers, long considered a cornerstone of post-heart attack care, provide no benefit to patients with uncomplicated myocardial infarction and preserved heart function. The “REBOOT Trial,” led by Mount Sinai’s Dr. Valentin Fuster and CNIC’s Dr. Borja Ibáñez, could transform cardiac care globally, overturning 40 years of standard treatment.
Key Findings from REBOOT
The REBOOT trial, presented at the European Society of Cardiology Congress and published in The New England Journal of Medicine, enrolled 8,505 patients across 109 hospitals in Spain and Italy. Patients were randomly assigned to receive or not receive beta blockers after hospital discharge and were followed for nearly four years. Results showed no significant difference in death, recurrent heart attack, or hospitalization for heart failure between the two groups, challenging the routine use of beta blockers in these cases.
Gender-Specific Risks
A substudy published in the European Heart Journal revealed that women treated with beta blockers had worse outcomes compared to women not receiving the drug. Specifically, women experienced a 2.7% higher absolute risk of mortality and increased hospitalizations for heart failure over the study period. This elevated risk was observed in women with fully preserved heart function, while men did not experience similar adverse effects.
Shifting Paradigms in Cardiac Care
Beta blockers have been standard treatment since the 1980s due to their ability to reduce oxygen demand and prevent arrhythmias in patients with significant heart damage. However, modern advances — including rapid reopening of blocked arteries — have lowered the risk of complications, calling into question the continued benefit of these drugs. Researchers argue that eliminating unnecessary beta blocker prescriptions could reduce side effects such as fatigue, bradycardia, and sexual dysfunction, while simplifying treatment plans for patients already on multiple medications.
Broader Impact on Guidelines
The REBOOT findings join other landmark trials, such as the SECURE and DapaTAVI studies, that have reshaped cardiovascular treatment strategies. Dr. Ibáñez emphasized that more than 80% of patients with uncomplicated heart attacks are currently discharged on beta blockers, and the new evidence represents “one of the most significant advances in decades.” Global guidelines are now expected to change, ensuring treatments align with modern scientific evidence rather than historical practice.
The REBOOT trial challenges decades of medical practice, showing beta blockers are unnecessary for most post-heart attack patients and may even harm women. By removing ineffective treatments from care protocols, clinicians can streamline therapy, improve quality of life, and set a new global standard for cardiac care.