Beta-Blockers Don’t Benefit All Heart Attack Survivors — and May Raise Heart Risks for Women

New research has found that beta-blockers — medications commonly prescribed to lower heart rate and blood pressure — did not offer clear benefits for certain heart attack patients.

Participants were assigned to either take a beta-blocker or not, within two weeks of leaving the hospital. Researchers found that over the course of almost four years, there was not a significant difference in all-cause death rates, repeat heart attacks, or heart failure hospitalizations between the two groups — suggesting that beta-blockers didn’t offer a notable benefit when taken following a heart attack.

Lead study author Borja Ibáñez, MD, PhD, says that while the results weren’t necessarily surprising — the clear lack of benefit was.

“Our initial suspicion was that beta-blockers had lost much of the benefit they once provided to this patient population,” says Dr. Ibáñez, who serves as director of clinical research at the National Center for Cardiovascular Research and an interventional cardiologist at Hospital Fundación Jiménez Díaz in Madrid.

All the existing research on this question came from older trials in very different contexts, he says.

Beta-Blockers May Actually Pose a Risk to Women Who Survive Heart Attack

“These findings mark a departure from long-held beliefs about beta-blockers and their effectiveness in the post-[heart attack] population,” says Omar K. Siddiqi, MD, a clinical associate professor of cardiovascular medicine at Boston University’s Chobanian & Avedisian School of Medicine in Massachusetts.

He says that while beta-blockers still have a role to play in treating heart attack survivors, the research points toward a more nuanced and personalized approach.

“Clinicians may need to consider factors like heart function as assessed by a heart ultrasound (echocardiogram) to see if a patient might benefit from a beta-blocker. These data suggest that beta-blockers are not routinely beneficial in all patients after a heart attack, and may even be harmful in some subgroups, such as women,” says Dr. Siddiqi.

What Are Beta-Blockers, and How Do They Work?

The latest findings may lead to changes in some of this guidance — particularly for people who recover normal heart function after a heart attack, Ibáñez says.

“This should not cause alarm: Medicine evolves as new evidence emerges. A good example is oxygen, which for decades was routinely given during acute myocardial infarction [heart attack] until a clinical trial showed no benefit — leading to its withdrawal from standard practice. The situation with beta-blockers is similar: Treatment that was once necessary may no longer be required under current standards of care,” he says.

What Women Taking Beta-Blockers Should Know About the Study Findings

The study authors point out that while there isn’t a clear explanation for why beta-blockers affect women differently, historically, women and men have not received equal post-heart-attack treatment management — with some previous studies finding that women tend to experience worse long-term health outcomes than men after a heart attack.

Siddiqi says it’s important to underline the nuances of the findings.

“There are definitely women who benefit from beta-blockers, particularly those with weaker heart function. But women who have had a heart attack and have normal heart function may be able to discontinue taking beta-blockers,” says Siddiqi.

“However, there are important caveats here, such as the presence of symptoms (known as angina) or heart rhythm problems. In these cases, women may still benefit from beta-blockers.”

How the Study Might Change Future Heart Attack Treatment Guidelines

But as Siddiqi notes, these guidelines are based on previous data, “before the routine use of urgent invasive therapies to open blocked arteries.” And right now, he says, there aren’t alternative drugs to recommend in the place of beta-blockers.

According to Ibáñez, the researchers believe their evidence is already robust enough to prompt a change in clinical practice, and are working on a new, larger meta-analysis to help further refine guidance on when beta-blockers should and should not be used after a heart attack.

He says one of the current trial limitations was that it was an open-label study — which means that both participants and doctors knew whether beta-blockers were prescribed at hospital discharge. In addition, he says, the type and dose of the beta-blockers were left to the treating physician’s discretion, which reflects real-world practice patterns.

“The key message is not to worry,” says Ibáñez. “Patients currently taking beta-blockers after a heart attack should not make any changes on their own. The right step is to discuss these results with their cardiologist at their next scheduled visit, where an individualized decision can be made.”