Low-Risk Patients With Previous Myocardial Infarction Could Stop Beta-Blockers After 1 Year

Stable, low-risk patients who have previously suffered a heart attack can safely discontinue beta-blockers after 1 year of treatment, according to new research presented at the American College of Cardiology’s Annual Scientific Session. This study indicates that for patients without heart failure or left ventricular systolic dysfunction, stopping the medication is noninferior to continuing it indefinitely in terms of preventing death, recurrent heart attacks, or hospitalizations.¹

“In appropriately selected patients who survived a heart attack and do not have heart failure or left ventricular systolic dysfunction, routine continuation of beta-blockers indefinitely may not be necessary,” Joo-Yong Hahn, MD, a cardiologist at Samsung Medical Center in Seoul, South Korea, said in a news release.

For over 40 years, beta-blockers have been the standard post-myocardial infarction treatment, but this paradigm is now being rigorously questioned by modern clinical trials. Many of the landmark studies that originally established their benefit were conducted decades ago, before the advent of modern revascularization and secondary prevention techniques. In the current era, where occluded coronary arteries are reopened rapidly and systematically, the risk of serious complications like arrhythmias is drastically lower, making the incremental benefit of lifelong beta-blockers unclear for stable populations.^1,2

“In practice, for stable patients who are several years out from a heart attack, discontinuation can be considered through shared decision-making and with monitoring of blood pressure and heart rate,” Hahn said.¹ “For patients with beta-blocker-related side effects—fatigue, dizziness, bradycardia, hypotension—the case for discontinuation is even stronger.”

In another trial, investigators further confirmed that beta-blockers provide no significant clinical benefit for patients with uncomplicated heart attacks and preserved heart function. This international REBOOT study, involving over 8500 patients, found no significant differences in rates of death or heart failure between those who continued the medication and those who stopped.²

Of particular concern for pharmacists is a REBOOT substudy, which revealed a gender-specific risk. Women with normal cardiac function treated with beta-blockers faced a 2.7% higher absolute risk of death, heart attack, or heart failure hospitalization compared to women not receiving the drug. This elevated risk was restricted to women with a left ventricular ejection fraction of 50% or higher, whereas men did not experience this increased risk.²

For pharmacists managing medication therapy, these findings highlight an opportunity to reduce polypharmacy and mitigate adverse effects that often impact quality of life. Beta-blockers, while generally considered safe, are frequently associated with side effects such as fatigue, dizziness, bradycardia, and sexual dysfunction. Hahn suggests that for stable patients several years out from an event, especially those struggling with these adverse effects, discontinuation can be considered through shared decision-making and careful monitoring of heart rate and blood pressure.^1,3

However, pharmacists must play a critical role in patient education by warning individuals never to suddenly stop taking a beta-blocker without medical supervision, as abrupt cessation can increase the risk of a heart attack or other serious heart problems.³

Although the conversation is shifting toward stopping therapy for low-risk patients, the pharmacist’s role in optimizing guideline-directed medical therapy (GDMT) remains vital for those who still require treatment, such as patients with heart failure with reduced ejection fraction. Pharmacist-led interventions in specialized clinics have been proven to significantly improve the utilization and dose optimization of the 4 pillars of GDMT: beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor-neprilysin inhibitor, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors.⁴

These optimizations are directly linked to improved survival and reduced hospitalizations. As global clinical practice prepares to evolve based on these new findings, pharmacists will be essential in identifying which patients truly benefit from continued beta-blocker therapy and which may safely transition away from them to improve their overall quality of life.

READ MORE: Cardiology Resource Center

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REFERENCES

1. Stopping beta-blockers after heart attack is safe for low-risk patients. News release. American College of Cardiology. March 30, 2026. Accessed March 30, 2026. https://www.acc.org/About-ACC/Press-Releases/2026/03/30/12/40/Stopping-Beta-Blockers-After-Heart-Attack-is-Safe-for-Low-Risk-Patients

2. Beta blockers, the standard treatment after a heart attack, may offer no benefit for heart attack patients and women can have worse outcomes. News release. Mount Sinai. September 2, 2025. Accessed March 30, 2026. https://www.mountsinai.org/about/newsroom/2025/beta-blockers-the-standard-treatment-after-a-heart-attack-may-offer-no-benefit-for-heart-attack-patients-and-women-can-have-worse-outcomes

3. Mayo Clinic. Beta blockers. March 27, 2025. Accessed March 30, 2026. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522

4. Patil T, Ali S, Kaur A, et al. Impact of Pharmacist-Led Heart Failure Clinic on Optimization of Guideline-Directed Medical Therapy (PHARM-HF). J Cardiovasc Transl Res. 2022;15(6):1424-1435. doi:10.1007/s12265-022-10262-9