The proverbial pendulum must be getting confused about which way to swing! At least that seems to be true in regard to the changing opinions on the value of Beta Blockers in patients who have just survived a heart attack. This debate has gone back and forth for decades, now, and opinions and conclusions come in all sizes and shapes. But three family doctors from the University of North Carolina in Chapel Hill recently concluded from “high quality randomized controlled trials that beta blockers given to patients post MI, DO NOT DECREASE the risk of death, non-fatal heart attack, non-fatal stroke, or hospitalization for another cardiovascular reason. However, they also admit that other reliable trials have shown just the opposite—beta blockers “reduce the risk of death and major adverse cardiovascular events.”
In another study, comparing beta blocker to non-beta blocker patients, there were no significant differences in death from any cause. But the incidence of subsequent heart attack was significantly lower in both groups. The mystery to me is “compared to what?” If both beta blocker and non-beta blocker groups had fewer MI’s, who was their control group? That is not explained. Another similar study came to the same conclusion. The American Heart Association and the American College of Cardiology both say giving beta blockers “may be reasonable” for doctors to “reassess long-term beta blocker use for specific patients with chronic coronary disease.”
The authors of the reference agree with that recommendation, but say “the usefulness and effectiveness has not been well-established.” So, our pendulum is hanging somewhere between yes and no and has yet to make up its mind which way to swing. We may never know.
Reference: Roten W, Mounsey A, Paulus R. Beta Blockers to Improve Post-MI Outcomes innOatients without heart failure. Am Fam Phys 2026 April;113(4):386-387.
