Beta-blockers Offer No Clinical Benefit For Myocardial Infarction Survivors With Preserved Cardiac Function

A awesome study led by nan Centro Nacional de Investigaciones Cardiovasculares (CNIC), successful collaboration pinch world institutions, has pooled information from 17,801 myocardial infarction survivors pinch preserved cardiac usability enrolled successful 5 world objective trials. The study concludes that beta-blockers connection nary objective use for this diligent group, which coming represents nan mostly of infarction survivors. The study was made imaginable by adjacent collaboration betwixt CNIC researchers and nan authors of nan different trials, who worked together astatine grounds velocity to present a definitive reply to a mobility affecting millions of patients worldwide.

The meta-analysis, published successful The New England Journal of Medicine and presented astatine nan American Heart Association (AHA) Congress successful New Orleans (USA), confirms that beta-blocker therapy-one of nan astir wide utilized treatments aft acute myocardial infarction-does not trim nan consequence of death, recurrent infarction, aliases bosom nonaccomplishment successful patients pinch preserved cardiac contractile function.

The study analyzed individual diligent information from each modern objective trials-REBOOT (Spain and Italy), REDUCE-AMI (Sweden), BETAMI (Norway), DANBLOCK (Denmark), and CAPITAL-RCT (Japan)-in patients recovering from infarction who had preserved cardiac usability (left ventricular ejection fraction ≥50%).

In nan analysis, half of nan participants received beta-blockers and half did not. After astir 4 years of follow-up, astir 8% of patients knowledgeable a awesome cardiovascular arena (death, recurrent infarction, aliases bosom failure). This complaint was akin successful some groups.

The main interrogator connected nan study was Dr. Borja Ibáñez, CNIC Scientific Director, cardiologist astatine Hospital Universitario Fundación Jiménez Díaz, and group leader astatine nan Spanish cardiovascular investigation web (CIBERCV). Dr. Ibañez-one of 4 elder investigators connected nan study-explains that nan researchers besides "found nary use erstwhile analyzing individual outcomes-total aliases cardiac mortality, recurrent infarction, bosom failure, aliases superior arrhythmias. The results were accordant crossed each diligent subgroups, sloppy of age, sex, aliases nan type of beta-blocker used."

As explained by Xavier Rosselló, CNIC scientist, cardiologist astatine Hospital Son Espases (Mallorca), and co–first writer of nan study, "This shows that beta-blockers supply nary use to immoderate subgroup of post-infarction patients pinch preserved cardiac function."

The findings successful female patients were of peculiar interest, since nan REBOOT proceedings had suggested that beta-blockers mightiness moreover beryllium harmful successful women. However, while nan meta-analysis indicated that women had much adverse events erstwhile treated pinch beta-blockers, it besides confirmed that nan quality was not statistically significant.

The investigators underline that nan CNIC is firmly committed to studying sex-based differences successful cardiovascular illness and curen responses.

Importantly, nan investigators besides statement that beta-blockers stay basal for different diligent groups, specified arsenic those pinch reduced near ventricular usability aft infarction (ejection fraction <50%) aliases those pinch chronic bosom nonaccomplishment aliases arrhythmias.

They besides accent that these findings do not mean that patients person been treated incorrectly until now. Rather, they show that caller advances successful infarction guidance person made beta-blockers unnecessary for infarction survivors pinch normal cardiac usability going forward.

The tests included successful this meta-analysis did not enroll patients who were already taking beta-blockers for different reasons (such arsenic bosom nonaccomplishment aliases arrhythmias), truthful nan conclusions use only to nan initiation of beta-blocker therapy aft infarction successful patients pinch normal cardiac function.

The REBOOT trial, led by nan CNIC successful collaboration pinch nan Spanish Society of Cardiology (SEC) and nan CIBERCV, and nan largest and astir robust of nan five, had already shown that patients pinch preserved cardiac usability aft infarction do not use from beta-blockers. Another caller study (BETAMI-DANBLOCK) suggested a flimsy use successful reducing recurrent infarction rates. Although this use was not observed successful nan different tests (REBOOT, REDUCE-AMI, CAPITAL-RCT), it was important to behaviour a pooled study to supply a definitive answer.

This meta-analysis unequivocally demonstrates that beta-blockers do not supply immoderate benefit-even successful position of reducing recurrent infarction rates-in patients pinch preserved cardiac usability aft infarction. The investigators affirm that "the awesome seen successful BETAMI-DANBLOCK apt reflects nan inclusion of a non-negligible proportionality of patients pinch mildly reduced cardiac function, a group known to use from beta-blockers."

They conclude: "Thanks to this collaborative effort, we now cognize really beta-blockers should beryllium utilized aft infarction: patients pinch preserved cardiac usability (ejection fraction ≥50%) do not benefit, while those pinch reduced usability (<50%) do."

Since astir 70% of infarction patients coming person preserved cardiac function, these findings person tremendous world implications.

Paradigm shift

For much than 40 years, each infarction patients were treated pinch lifelong beta-blockers, sloppy of bosom function. This believe was based connected objective tests from nan 1970s and 1980s that showed benefit. But infarction guidance has changed dramatically since then, and diligent outcomes person improved, pinch little risks of malignant arrhythmias and bosom failure. The REBOOT trial, led by nan CNIC, had already pointed to a paradigm shift. This meta-analysis confirms it: patients pinch preserved cardiac usability aft infarction do not use from beta-blockers.

In 2025, we person overturned a curen paradigm that had gone unquestioned for decades. From now on, patients discharged aft infarction pinch normal cardiac usability will nary longer person beta-blockers. This is 1 of nan astir important changes successful cardiology successful caller decades. We suspected this for years, but only now-thanks to these studies-can we present an irrefutable message."

Dr. Valentín Fuster, CNIC General Director, President of nan Mount Sinai Fuster Heart Hospital, and interrogator connected some REBOOT and nan meta-analysis

The researchers stress that beta-blockers are secure medications pinch a agelong way grounds of use, and they impulse patients not to discontinue them without first consulting their doctor. "It's important to speak pinch a physician," explains Dr. Ibañez, "because immoderate patients whitethorn beryllium taking beta-blockers for reasons different than infarction, and successful those cases nan curen should continue." This is not an urgent issue, but thing to raise astatine nan adjacent scheduled follow-up. "If nan expert confirms that nan diligent is taking beta-blockers solely because of a past infarction and has normal cardiac function, nan curen will astir apt beryllium discontinued." Although beta-blockers person a very favorable information profile, they are not wholly free of broadside effects. While these are mostly mild, they tin impact value of life, producing fatigue aliases intersexual dysfunction. The caller findings truthful guidelines to amended value of life for these patients.

This study will undoubtedly person a awesome effect connected objective believe guidelines worldwide. As Dr. Fuster notes, "This study joins others coordinated by nan CNIC-such arsenic PESA, SECURE, and DapaTAVI-that are transforming world objective practice."

The CNIC has go 1 of nan world's astir influential investigation centers successful nan test and curen of cardiovascular disease.

The study was supported by backing from nan CNIC; nan Swedish Research Council; nan Swedish Heart and Lung Foundation; nan Stockholm Regional Authority; nan South-Eastern Norway Regional Health Authority; nan Norwegian Research Council; nan Danish Heart Foundation; nan Novo Nordisk Foundation; and nan Research Institute for Production Development, Kyoto, Japan.