Coordination gap
The answer is roughly known; the field just hasn't synchronized practice.
Resolves via: Guideline update + dissemination
Get this wrong and millions of stable post-MI patients either swallow a daily pill for nothing or lose real arrhythmia and remodeling protection.
Active since Apr 2024
The debate
21 clinicians quoted on the record
Modern trials in patients with preserved EF show no survival or event benefit, so continuing only adds side effects, fatigue, and pill burden with nothing to gain.
“Beta-blockers have long been a foundational treatment after acute MI; however, supporting evidence is derived from trials that predate modern standards of care − before the time of routine reperfusion, invasive management, potent antiplatelet therapies and statins. Re-examining t”
“REBOOT clearly showed no signal of benefit for post-MI beta-blockers.”
+ 3 more on this side
Beta-blockers still guard against arrhythmias and adverse remodeling, and the newer trials may miss harder, longer-term events the older data captured.
“Patients post-MI with mildly reduced LVEF (40−49%) but without HF represent a sizeable population.”
Where the experts land
5–1 on record · 15 unplaced
Stop the beta-blocker · 5
On the record, unplaced · 15
Keep it going · 1
“Beta-blockers have long been a foundational treatment after acute MI; however, supporting evidence is derived from trials that predate modern standards of care − before the time of routine reperfusion, invasive management, potent antiplatelet therapies and statins. Re-examining t”
Where the field stands
Common ground
The case for routine beta-blockers rests on old trials, and any benefit with preserved heart function is small at best.
The crux
Should beta-blockers be stopped after an uncomplicated heart attack, especially when pumping is only mildly reduced?
Still unknown
A trial built specifically for the mildly reduced pumping group, plus data on safely stopping the drug, would settle it.
On the record
Their own words — position stated as published
do not rush to stop everyone
“Don't rush out and everybody stop beta-blockers post myocardial infarction. These patients were very carefully selected.”
John G. F. Cleland · Heart-failure trialist · 5 statements · MedPage Today ↗
stop if EF preserved
“In 2025, we have overturned a treatment paradigm that had gone unquestioned for decades. From now on, patients discharged after infarction with normal cardiac function will no longer receive beta-blockers.”
Valentin Fuster · CNIC / Mount Sinai; REBOOT investigator · 5 statements · EurekAlert ↗
safe to stop after 1 year if stable
“In appropriately selected patients who survived a heart attack and do not have HF or left ventricular systolic dysfunction, routine continuation of beta-blockers indefinitely may not be necessary.”
Joo-Yong Hahn · Senior author · 3 statements · ACC ↗
keep if mildly reduced EF
“They all point in this direction—that there is a benefit in the subgroup with ejection fraction below 50%.”
Eva Prescott · Co-PI · 3 statements · TCTMD ↗
Where do you land?
No votes yet — the measured split appears at 10.
Where the evidence stands
REBOOT found no MACE benefit of long-term beta-blockade when LVEF is >40%. BETAMI-DANBLOCK found a modest 15% relative MACE reduction driven by nonfatal reinfarction. Individual-patient meta-analyses then split the field: no benefit at LVEF ≥50%, possible benefit at mildly reduced EF (40–49%). Absolute effects are small and the 2025 ACC/AHA ACS guideline still gives early oral beta-blockade a Class 1 recommendation, which some authors have called overgraded.
What's settled
4What's still open
4How this gets settled
Who could settle it
Know an expert who could settle this? Suggest one →
Who could fund or run it
Institutions that could fund, run, or adopt
Sources & verification
+ 58 more, each dated and verification-tagged
Who we found publicly on the record — a snapshot, not a poll of the field. Larger dots are deciders; dashed dots are scan-reported, not yet verified.