“REBOOT Trial” reveals beta blockers—medicine generally prescribed for coronary heart assaults—might provide no scientific profit for these sufferers. Credit score: Mount Sinai Well being System
Beta blockers—medicine generally prescribed for a variety of cardiac situations, together with coronary heart assaults—present no scientific profit for sufferers who’ve had an uncomplicated myocardial infarction with preserved coronary heart perform. Beta blockers have been the usual remedy for these sufferers for 40 years.
This can be a breakthrough discovery from the “REBOOT Trial” with senior investigator Valentin Fuster, MD, Ph.D., President of Mount Sinai Fuster Coronary heart Hospital and Common Director of Spain’s Centro Nacional de Investigaciones Cardiovasculares (CNIC).
The research outcomes, which might overturn a normal remedy paradigm, had been offered on Saturday, August 30, throughout a “Hot Line” session on the European Society of Cardiology Congress in Madrid, and concurrently printed in The New England Journal of Medication.
Moreover, a REBOOT substudy, printed Saturday, August 30, within the European Coronary heart Journal, reveals that ladies handled with beta blockers had a better danger of loss of life, coronary heart assault, or hospitalization for coronary heart failure in comparison with ladies not receiving the drug. Males didn’t have this elevated danger.
“This trial will reshape all international clinical guidelines. It joins other previous landmark trials led by CNIC and Mount Sinai—such as SECURE with the polypill and DapaTAVI, with SLT2 inhibition associated to TAVI—that have already transformed some global approaches to cardiovascular disease,” says Dr. Fuster.
The SECURE trial confirmed a polypill, a single capsule that mixes three medicines—which incorporates aspirin, ramipril, and atorvastatin—reduces cardiovascular occasions by 33% in sufferers handled with this after a coronary heart assault. The DapaTAVI trial confirmed each dapagliflozin and the associated medicine empagliflozin—medicine used to deal with diabetes- improves the prognosis of sufferers with aortic stenosis handled by transcatheter aortic valve implantation.
“REBOOT will change clinical practice worldwide,” says Principal Investigator Borja Ibáñez, MD, CNIC’s Scientific Director, who offered the outcomes. “Currently, more than 80% 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.”
Though typically thought of secure, beta blockers could cause unwanted effects akin to fatigue, bradycardia (low coronary heart charge), and sexual dysfunction. For greater than 40 years, beta blockers have been prescribed as a normal remedy after a coronary heart assault, however their profit within the context of contemporary therapies was unproven. The REBOOT trial, is the most important scientific trial on this topic. The worldwide research was coordinated by CNIC in collaboration with the Mario Negri Institute for Pharmacological Analysis in Milan.
Researchers enrolled 8,505 sufferers throughout 109 hospitals in Spain and Italy. Individuals had been randomly assigned to obtain or not obtain beta blockers after hospital discharge. All sufferers in any other case obtained the present commonplace of care and had been adopted for a median of almost 4 years. The outcomes confirmed no vital variations between the 2 teams in charges of loss of life, recurrent coronary heart assault, or hospitalization for coronary heart failure.
A REBOOT subgroup evaluation discovered that ladies handled with beta blockers skilled extra hostile occasions. Outcomes present ladies handled with beta-blockers had a 2.7% increased absolute danger of mortality in comparison with these not handled with beta-blockers throughout the 3.7 years of follow-up of the research.
The elevated danger when handled with beta-blockers was restricted to ladies with a whole regular cardiac perform after a coronary heart assault (left ventricular ejection fraction of fifty% or increased). These with a light deterioration in cardiac perform didn’t have an extra danger of hostile outcomes when handled with beta-blockers.
“After a heart attack, patients are typically prescribed multiple medications, which can make adherence difficult,” explains Dr. Ibáñez. “Beta blockers had been added to plain remedy early on as a result of they considerably diminished mortality on the time. Their advantages had been linked to diminished cardiac oxygen demand and arrhythmia prevention.
“But therapies have evolved. Today, occluded coronary arteries are reopened rapidly and systematically, drastically lowering the risk of serious complications such as arrhythmias. In this new context—where the extent of heart damage is smaller—the need for beta blockers is unclear. While we often test new drugs, it’s much less common to rigorously question the continued need for older treatments.”
That was the motivation behind REBOOT.
“The trial was designed to optimize heart attack care based on solid scientific evidence and without commercial interests. These results will help streamline treatment, reduce side effects, and improve quality of life for thousands of patients every year,” Dr. Ibanez provides.
REBOOT was carried out with out pharmaceutical trade funding.
Extra data:
Beta-Blockers after Myocardial Infarction with out Lowered Ejection Fraction, New England Journal of Medication (2025).
European Coronary heart Journal (2025).
Offered by
The Mount Sinai Hospital
Quotation:
Beta blockers might provide no profit for coronary heart assault sufferers, and ladies can have worse outcomes (2025, August 30)
retrieved 30 August 2025
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