Do All Heart Attack Survivors Need Beta-Blockers? New Research Challenges Old Assumptions

For decades, beta-blockers have been considered a cornerstone of treatment after a heart attack (myocardial infarction, or MI). These medications lower heart rate and blood pressure, reducing strain on the heart. But new studies are raising questions: do all patients truly benefit — especially those whose heart pumping function (ejection fraction, EF) remains normal?

📊 What the Latest Studies Show

1. REDUCE-AMI (2024)

This large trial looked at more than 5,000 post-MI patients with preserved EF (≥50%). Patients were randomly assigned to take a beta-blocker (metoprolol or bisoprolol) or no beta-blocker. The result? No difference in risk of death or another heart attack during follow-up.

2. ABYSS (2024)

This study followed patients one year after an uncomplicated heart attack. Some continued their beta-blocker, while others stopped. Stopping did not prove non-inferior, suggesting it’s still reasonable to continue therapy at one year — though this trial wasn’t limited to normal EF patients.

3. REBOOT (2025)

Another recent trial included patients with MI and EF ≥40%. Beta-blockers did not reduce deaths, repeat heart attacks, or hospitalizations for heart failure overall. Interestingly, some benefit was hinted at in those with EF between 40–49%, but not with fully preserved EF.

4. BETAMI & DANBLOCK (2025)

These additional trials also looked at patients with preserved EF and found no consistent benefit of long-term beta-blocker use.

🧭 What This Means for Patients

• Beta-blockers remain essential for people with weakened heart function (EF <50%), heart failure, certain arrhythmias, ongoing angina, or uncontrolled blood pressure.
  

• For patients with normal heart function after MI (EF ≥50%), the benefit of long-term beta-blockers is now uncertain. Many experts suggest it may be safe to avoid starting them, or to taper off after recovery if there’s no other reason to continue.
  

• Patients with borderline EF (40–49%) may still see some advantage, but more research is needed.
  

💬 Bottom Line

The latest evidence suggests that one size does not fit all when it comes to beta-blockers after a heart attack. If your heart function is normal and you don’t have another indication, you may not need to take a beta-blocker for life.

Always talk with your doctor before making changes. The right plan depends on your heart’s function, your symptoms, and your overall health. And always, our goal with these articles is to keep you informed and empowered about your health. If you’re ready to take the next step and partner with a primary care physician who prioritizes your well-being, reach out to us here.

Disclaimer:

✍️ This blog is for educational purposes only and should not replace medical advice. If you’ve had a heart attack, ask your healthcare provider whether beta-blockers are right for you in the long term.