Treatment with beta-blocker therapy did not reduce the incidence of all-cause death, myocardial infarction (MI) or heart failure (HF) in patients with a preserved LVEF (≥50%) after a recent MI, according to results of a meta-analysis presented at AHA 2025 and simultaneously published Nov. 9 in NEJM.

Anna Meta Dyrvig Kristensen, MD, et al., pooled individual-level data from patients with preserved LVEF in five contemporary randomized trials: REBOOT (n=7,459), REDUCE-AMI (n=4,967), BETAMI (n=2,441), DANBLOCK (n=2,277) and CAPITAL-RCT (n=657). Among the 17,801 total patients (median age, 62 years; 21% women), half were assigned to receive a beta-blocker and half did not.

Results showed that during a median 3.6-year follow-up, a primary endpoint event (all-cause death, MI or HF) occurred in 8.1% of patients (2.37 events per 100 patient-years) in the beta-blocker group and 8.3% (2.45 events per 100 patient-years) in the no beta-blocker group (hazard ratio [HR], 0.97; 95% CI, 0.87-1.07; p=0.54).

Specifically, for patients in the beta-blocker vs. no beta-blocker groups, respectively: all-cause death occurred in 3.8% vs. 3.6% (HR, 1.04); MI occurred in 4.1% vs. 4.5% (HR, 0.89); and HF occurred in 0.8% vs. 1.0% (HR, 0.87).

In other findings, cardiac death occurred in 1.3% of patients taking beta-blockers vs. 1.0% not taking beta-blockers. Unplanned coronary revascularization occurred in 5.0% and 4.9% of the two respective groups.

Regarding safety events, ischemic stroke occurred in 1.3% of patients in the beta-blocker group vs. 1.0% in the no beta-blocker group. Advanced atrioventricular block occurred in 0.8% of patients in both groups.

Kristensen and colleagues write that the overall neutral findings "appeared to be consistent for each individual component of the primary endpoint, other secondary endpoints, and safety endpoints, as well as across prespecified subgroups."

Importantly, the authors point out that the results differ from a recent meta-analysis of patients with reduced LVEF (40-49%) taking beta-blockers, which showed a 25% relative reduction in the composite of all-cause death, MI or HF. "These findings are not unexpected given that LVEF is a strong prognostic factor" in patients with MI and HF, which may explain why beta-blockers in this population with preserved LVEF were "less relevant."