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December 9, 2025
OSLO/COPENHAGEN — For decades, beta-blockers have been the “bread and butter” of heart attack treatment—prescribed almost automatically to survivors to prevent a second event. In recent years, however, the medical community began to turn against this practice, with major studies suggesting these drugs were unnecessary for patients with good heart function.
Now, a massive Scandinavian study has upended that narrative, delivering unexpected results that could rewrite the rulebook for millions of heart patients. The findings, from the combined BETAMI and DANBLOCK trials, reveal that for a crucial subgroup of survivors, these inexpensive, decades-old drugs are not obsolete—they are life-savers.
The “Old Guard” Returns
Beta-blockers work by slowing the heart rate and lowering blood pressure, reducing the workload on the heart. Since the 1980s, they have been standard care. But medicine has evolved; today, doctors clear blocked arteries within minutes using stents, and patients take powerful statins and antiplatelet drugs. In this modern context, many experts believed beta-blockers had become redundant for patients whose hearts were not significantly damaged.
“Evidence supporting beta-blocker therapy after myocardial infarction [heart attack] was established before the introduction of modern coronary reperfusion therapy,” explains Professor Dan Atar, head of research at Oslo University Hospital Ullevaal and a lead investigator of the study.
The medical community was ready to phase them out for low-risk patients. Then came the results of the BETAMI-DANBLOCK trials, presented at the European Society of Cardiology Congress and published in the New England Journal of Medicine.
The Unexpected Findings
The study followed over 5,500 patients in Norway and Denmark who had survived a heart attack but retained “preserved” or “mildly reduced” heart pumping function (measured as a Left Ventricular Ejection Fraction, or LVEF, of 40% or higher). Half received beta-blockers; half did not.
Contrary to the growing skepticism, the group taking beta-blockers fared significantly better. They experienced a 15% reduction in the risk of serious cardiovascular events, including death, new heart attacks, or heart failure (Hazard Ratio 0.85).
Specifically, the drug reduced the risk of a recurrent heart attack by 27% (5.0% incidence vs. 6.7%).
“Our findings suggest that, despite advances in contemporary treatment, the beneficial effects of beta-blocker therapy remain clinically relevant,” said Professor Eva Prescott of Copenhagen University Hospital, a principal investigator for the Danish arm of the study.
The “Gray Zone” Clarified
Why did this study find a benefit when others, like the recent REBOOT trial in Spain and Italy, did not? The answer lies in the nuance of “heart function.”
Heart function is measured by ejection fraction (EF)—the percentage of blood the heart pumps out with each beat.
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Normal/Preserved: EF above 50%
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Mildly Reduced: EF between 40-49%
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Reduced: EF below 40% (Heart Failure range)
While previous studies lumped everyone with an EF over 40% together or focused heavily on those with perfectly normal hearts (>50%), the BETAMI-DANBLOCK trial shone a light on the “mildly reduced” (40-49%) group.
A subsequent meta-analysis, which pooled data from BETAMI, DANBLOCK, and other major trials (REBOOT, REDUCE-AMI), clarified the picture:
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For patients with truly normal hearts (>50% EF): Beta-blockers offered no clear benefit, confirming that for the healthiest survivors, the drugs may indeed be unnecessary.
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For patients in the 40-49% “gray zone”: Beta-blockers reduced the risk of death, heart attack, or heart failure by approximately 25%.
Expert Perspectives
The findings have sparked a shift from a “one-size-fits-all” approach to precision medicine.
Dr. Borja Ibáñez, Scientific Director at the CNIC in Spain and lead investigator of the REBOOT trial, views the collective data as a turning point. While he argues the data puts the “final nail in the coffin” for routine use in patients with perfectly normal heart function, he acknowledges the critical importance of the drug for others.
“We know that beta-blockers are still beneficial for other populations,” Dr. Ibáñez noted in a statement to the press. “For example, patients with mildly reduced ejection fraction… clearly benefit.”
Dr. Johanne Silvain, a cardiologist at Sorbonne University in Paris who was not involved in the Scandinavian study, warns against oversimplifying the “stop beta-blockers” trend.
“My concern is that the current narrative risks portraying beta-blocker withdrawal as broadly safe,” Dr. Silvain cautioned. “Many others—those with larger infarcts, mild LV dysfunction… continue to derive clear benefit. In these subgroups, discontinuation could be harmful.”
Implications for Patients
For the millions of people currently taking beta-blockers (such as metoprolol or bisoprolol), these findings are reassuring but require careful interpretation.
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Do not stop taking medication abruptly. The study found no safety issues with long-term use, and stopping without medical supervision can be dangerous.
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Know your number. Patients should ask their cardiologist about their “Ejection Fraction” (EF).
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If your EF is below 50%, this new evidence suggests beta-blockers are likely protecting you from a second heart attack.
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If your EF is above 50% and you have no other issues (like arrhythmia or angina), your doctor might consider deprescribing the drug to reduce pill burden and side effects like fatigue.
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“The practical message is simple,” says Professor Atar. “Medication decisions should never be changed on their own, and the best next step is a detailed conversation with a treating cardiologist who can weigh personal risks and benefits.”
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
References
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Primary Study: Munkhaugen, J., et al. (2025). “Beta-Blockers after Myocardial Infarction in Patients without Heart Failure.” The New England Journal of Medicine. DOI: 10.1056/NEJMoa2505985.
For a deeper dive into the study’s presentation at the European Society of Cardiology, you can watch the lead investigators discuss the findings here: Hot Line 3: BETAMI-DANBLOCK Presentation
This video features Professor Dan Atar and Professor Eva Prescott presenting the primary data directly from the ESC Congress, offering a firsthand look at the statistical breakdown and clinical interpretation of the trial.
