No Benefit of Beta Blockers in Certain Heart Attack Patients: REBOOT Trial Finds

In a new study published in The New England Journal of Medicine and European Heart Journal, researchers revealed that beta blockers-long considered a cornerstone of post-heart attack care—offer no clinical benefit for patients who have had an uncomplicated myocardial infarction with preserved heart function. The results of the REBOOT trial were presented during a “Hot Line” session at the European Society of Cardiology Congress in Madrid and are expected to prompt a major shift in clinical guidelines. Beta blockers have been routinely prescribed for over four decades to reduce the risk of repeat cardiac events following a heart attack. However, with advances in cardiac care, their role in patients with no complications and preserved ejection fraction had remained untested in large-scale trials—until now. The REBOOT trial, coordinated by Spain’s CNIC and the Mario Negri Institute in Milan, enrolled 8,505 patients across 109 hospitals in Spain and Italy. Participants—all of whom had preserved heart function following a heart attack—were randomly assigned to receive or not receive beta blockers after hospital discharge. All other aspects of care followed current clinical standards. Patients were followed for a median of 3.7 years. The results showed no significant difference between the two groups in terms of mortality, recurrent heart attacks, or hospitalizations due to heart failure. A key substudy, published in the European Heart Journal, revealed an important sex-specific finding: women treated with beta blockers had a 2.7% higher absolute risk of death, heart attack, or heart failure hospitalization than those who were not, while men showed no such increased risk. “This trial will reshape all international clinical guidelines,” said Dr. Valentin Fuster, senior investigator and President of Mount Sinai Fuster Heart Hospital. “REBOOT will change clinical practice worldwide,” added Principal Investigator Dr. Borja Ibáñez. “Currently, more than 80 percent 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.” This study not only questions the continued use of legacy treatments but also aims to simplify care, minimize side effects, and improve long-term outcomes for heart attack survivors.