Decades of heart drug prescriptions questioned as major trial finds no benefit, risks for women
By isabelle // 2025-09-02
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  • Doctors have prescribed beta blockers to heart attack survivors for 40 years assuming they prevent repeat cardiac events.
  • A massive new study reveals beta blockers provide no clinical benefit for most patients and may increase death risk in women.
  • The REBOOT trial followed 8,505 patients, finding no improvement in survival rates, repeat heart attacks, or hospitalizations.
  • Women with normal heart function on beta blockers faced a 2.7% higher absolute risk of death compared to non-users.
  • Modern treatments have made beta blockers obsolete for many, yet 80% of patients still receive them.
For 40 years, doctors have routinely prescribed beta blockers to heart attack survivors, believing the drugs reduce the risk of another cardiac event. But a groundbreaking new study—the largest of its kind—has exposed a shocking truth: these medications provide no clinical benefit for most patients and may even increase the risk of death in women. The findings, published in The New England Journal of Medicine and presented at the European Society of Cardiology Congress, come from the REBOOT trial, which followed 8,505 patients across Spain and Italy. Researchers found that beta blockers, long considered a cornerstone of post-heart attack care, failed to improve survival rates, prevent repeat heart attacks, or reduce hospitalizations for heart failure. Even worse, a substudy revealed that women with normal heart function who took beta blockers had a 2.7% higher absolute risk of death compared to those who didn’t. Meanwhile, men experienced no such risk. So why are these drugs still being prescribed to more than 80% of heart attack patients worldwide?

A medical paradigm shattered

The REBOOT trial, led by Dr. Valentin Fuster of Mount Sinai Fuster Heart Hospital and Dr. Borja Ibáñez of Spain’s National Center for Cardiovascular Investigation, challenges decades of medical dogma. “This trial will reshape all international clinical guidelines,” said Dr. Fuster. Beta blockers, which slow heart rate and reduce blood pressure, were first introduced when heart attack treatments were far less advanced. Today, modern interventions such as rapid stent placement and blood thinners have drastically improved survival rates, making the need for beta blockers obsolete in many cases. Yet despite the lack of proven benefit, millions of patients continue taking them, often suffering side effects like fatigue, low blood pressure, and sexual dysfunction. “While we often test new drugs, it’s much less common to rigorously question the continued need for older treatments,” Dr. Ibáñez noted.

Why are women at higher risk?

The study’s most alarming finding was the gender disparity: Women with preserved heart function (ejection fraction above 50%) who took beta blockers had worse outcomes than those who didn’t. “Gender has a lot to do with how people respond to medication,” explained Dr. Andrew Freeman, a cardiologist at National Jewish Health who was not involved in the study. "In many cases, women have smaller hearts. They’re more sensitive to blood pressure medications. Some of that may have to do with size, and some may have to do with other factors we have yet to fully understand.” Historically, heart disease research has focused on men, leading to delayed recognition of how differently women experience cardiac conditions. The REBOOT trial’s female participants—although older and sicker on average—provided the largest dataset ever on beta blockers in women post-heart attack.

What does this mean for patients?

The study doesn’t suggest that all beta blocker use is harmful. Patients with reduced heart function (ejection fraction below 40%) still benefit from the drug’s ability to prevent dangerous arrhythmias. However, for the vast majority of heart attack survivors—those with normal or near-normal heart function—the evidence now suggests beta blockers offer no advantage and may even pose risks. Dr. Steven Pfau of Yale School of Medicine cautioned that while the findings are significant, more research is needed to determine which patients truly benefit. “If beta blockers do have an effect, it is probably small, given the other therapies we have,” he said. For now, patients should consult their doctors before stopping any medication. But the REBOOT trial’s conclusions demand a re-evaluation of long-standing medical guidelines and a hard look at why unproven treatments remain standard practice for decades.

Big Pharma’s shadow over medicine

One striking detail about the REBOOT trial? It was conducted without pharmaceutical industry funding. This raises an important question: How many other widely prescribed drugs lack real evidence of benefit? The medical establishment’s reliance on outdated practices—often influenced by industry interests—has real-world consequences. Beta blockers are just one example of how regulatory capture and financial incentives can distort medical care. For years, patients have been told these drugs are essential, yet the largest study to date proves otherwise. Sources for this article include: ScienceDaily.com CNN.com ABCNews.go.com
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