What does this research mean for the field?

In patients with acute myocardial infarction complicated by heart failure, in-hospital beta-blocker use is associated with a lower 1-year risk of adverse outcomes in those with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF), but not in those with preserved ejection fraction (HFpEF). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the association between in-hospital beta-blocker therapy and 1-year clinical outcomes in patients with acute myocardial infarction complicated by heart failure, stratified by left ventricular ejection fraction phenotype.

August 22, 2026JACC AdvancesOpen Access

Beta-Blocker Use After Acute Myocardial Infarction

Q: What are the key findings of this study?

In-hospital beta-blocker therapy was associated with a 41% lower risk of the 1-year composite of cardiac death or heart failure rehospitalization in patients with AMI and HFrEF/HFmrEF, but not in HFpEF.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction complicated by heart failure (n=5557). Intervention: In-hospital beta-blocker therapy vs. No in-hospital beta-blocker therapy. Primary outcome: 1-year composite of cardiac death or heart failure rehospitalization (aHR 0.590, 95% CI 0.438-0.795, p=<0.001).

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Key result

In-hospital beta-blockers linked to ~41% lower 1-year major events in post-AMI HFrEF/HFmrEF, but not HFpEF.

aHR 0.590
95% CI 0.438-0.795
P<0.001
n=5,557

Why the study?

Beta-blocker benefits after acute myocardial infarction may differ by heart failure phenotype in the contemporary reperfusion era.

Does in-hospital beta-blocker therapy reduce the 1-year composite of cardiac death or heart failure rehospitalization in patients with acute myocardial infarction complicated by heart failure?

Population

5,557 patients with AMI complicated by HF

Comparison

In-hospital BB therapy vs no BB therapy

Design

Observational database study using inverse probability of treatment weighting

Follow-up

Median 1,566 days

Authors

TGTianshu GuSecond Hospital of Tianjin Medical University SHSutao HuSecond Hospital of Tianjin Medical University YZYukun ZhangSecond Hospital of Tianjin Medical University

Discussion

Member takes

Implication

May support selective in-hospital beta-blockers in post-AMI HFrEF/HFmrEF; hypothesis-generating and requires randomized confirmation by EF phenotype.

Key Points

To evaluate the association between in-hospital beta-blocker therapy and 1-year clinical outcomes in patients with acute myocardial infarction complicated by heart failure, stratified by left ventricular ejection fraction phenotype.
Analyzed 5,557 patients with acute myocardial infarction complicated by heart failure from the Tianjin Coronary Artery Disease Specialized Database, including 3,962 (71.3%) with HFpEF and 1,595 (28.7%) with HFrEF/HFmrEF.
Assessed in-hospital beta-blocker therapy against a primary composite endpoint of cardiac death or heart failure rehospitalization within 1 year across a median follow-up of 1,566 days.
Employed inverse probability of treatment weighting, multivariable Cox models, competing risk analyses, and propensity score matching to adjust for confounders.
The primary composite outcome occurred in 859 of 5,557 patients overall (15.5%; 95% CI: 14.5%-16.4%), with a significant interaction between beta-blocker use and heart failure phenotype (HR: 0.704; 95% CI: 0.509-0.974; P = 0.034).
In HFrEF/HFmrEF, beta-blocker therapy was associated with a significantly lower risk of the primary endpoint (adjusted HR: 0.590; 95% CI: 0.438-0.795; P < 0.001), but no significant association was observed in HFpEF.
Beta-blocker use in HFrEF/HFmrEF was also associated with lower risks of cardiac death (adjusted HR: 0.536; 95% CI: 0.349-0.823; P = 0.004) and all-cause death (adjusted HR: 0.577; 95% CI: 0.395-0.841; P = 0.004).

Study Design

Type

Cohort (n=5,557)

Multicenter

Yes

Structured PICO

Does in-hospital beta-blocker therapy reduce the 1-year composite of cardiac death or heart failure rehospitalization in patients with acute myocardial infarction complicated by heart failure?

Population

5,557 adult patients with acute myocardial infarction complicated by heart failure (3,962 HFpEF and 1,595 HFrEF/HFmrEF), followed for a median of 1,566 days.

Exposure

In-hospital beta-blocker therapy (prescribed long-term beta-blocker medical orders during the index hospitalization).

Comparator

No beta-blocker therapy during the index admission.

Outcome

1-year composite of cardiac death or heart failure-related rehospitalization.composite

Main Result

Hazard Ratio: 0.59 (95% CI 0.438–0.795)

p-value: p=<0.001

Limitations

Observational study design with potential residual confounding and selection bias
Lack of data on long-term beta-blocker dose titration or postdischarge adherence
Patients receiving beta-blockers had more favorable baseline profiles
Outcomes limited to 1-year follow-up
Lack of systematic follow-up LVEF data to assess recovery or deterioration
Limited availability of echocardiographic and imaging data in the registry

Cite This Study

Gu et al. (2026) conducted a cohort in Acute myocardial infarction complicated by heart failure (n=5,557). In-hospital beta-blocker therapy vs. No in-hospital beta-blocker therapy was evaluated on 1-year composite of cardiac death or heart failure rehospitalization (aHR 0.590, 95% CI 0.438-0.795, p=<0.001). In-hospital beta-blocker therapy was associated with a 41% lower risk of the 1-year composite of cardiac death or heart failure rehospitalization in patients with AMI and HFrEF/HFmrEF, but not in HFpEF.

synapsesocial.com/papers/6a895f41ca7ade938187db21 https://doi.org/10.1016/j.jacadv.2026.103168

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Implication

May support selective in-hospital beta-blockers in post-AMI HFrEF/HFmrEF; hypothesis-generating and requires randomized confirmation by EF phenotype.

Beta-Blocker Use After Acute Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Beta-Blocker Use After Acute Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider