POST-MI BETA BLOCKER USE SHOULD CEASE
On August 6, 2025, DrGOpines.com posted an article titled “Post-MI Beta Blockers Questioned.” In it, the routine prescribing of Beta Blocker drugs (metoprolol, carvedilol, bisoprolol) for patients after a heart attack (MI—myocardial infarction) was being questioned. Researchers had found that patients on Beta blockers fared no better than patients not on Beta blockers—they had no better outcomes (another MI, stroke, or cardiovascular death). Dr.G’s personal opinion of this was that this was heresy! I thought Beta Blockers were a “gift” that should be continued.
Now comes another article that substantiates the lack of improved outcomes post-MI from Beta blockers. A cardiac electrophysiologist from Louisville, KY cites results from four large studies that once again conclude patients fare no better on Beta blockers than if they’re not. The studies he cites are crazy acronyms which to a lay person only confuse things more. BUT they are the REBOOT, CAPITAL-RCT, REDUCE-AMI, and BETAMI-DANBLOCK trials. These studies found “no differences in death, Cardiovascular death, or other outcomes.” Unless a patient had another reason (a so-called separate indication) for needing a Beta blocker, taking them posed a greater risk of adverse side effects than they did of positive benefit.
Thus, the author summarized that “The totality of evidence clearly supports a reversal in practice….the mandates and quality measures for routine use of post-MI Beta blockers should end tomorrow. The meta-lesson….is that our established therapies require expiration dates. As practices change, we should be open to challenging established beliefs.” He strongly asserts the routine practice of prescribing Beta blockers for patients after heart attack has no benefit and should cease. The argument supporting his position is strong so who am I to disagree.
Dr. G’s Opinion: I stand corrected!
Reference: Mandrola JM. Beta-Blockers Post-MI: A Clear Clinical Message. Medscape 2025 August 31.
