A medication millions of heart attack survivors take every day for the rest of their lives may not need to be taken forever, according to a major new study.
The study found that going off beta-blockers within a year after a heart attack does not increase a person’s risk of having a subsequent heart attack or dying from other heart-related diseases.
For decades, surviving a heart attack has often meant lifelong treatment with beta-blocker medications, but doctors are now questioning whether indefinite use is truly necessary.
In current practice, many stable patients remain on beta-blockers for years solely because of a previous heart attack, “despite potential adverse effects and medication burden,” Dr. Joo-Yong Hahn, a cardiologist at Samsung Medical Center in Seoul, South Korea, and senior author of the study, told The Epoch Times.
“In today’s practice, where many patients undergo procedures to restore blood flow and secondary prevention measures are strong, we expected that continuing beta-blockers indefinitely might offer limited additional benefit.”
Ceasing Beta-Blockers ‘Not Worse’ Than Continuing
The study, published in The New England Journal of Medicine, followed 2,540 patients across 25 sites in South Korea between 2021 and 2023. All participants had taken beta-blockers for at least one year after a heart attack and had no subsequent cardiac events.
Researchers then randomly assigned participants to either stop or continue the medication and tracked outcomes over an average of 3 1/2 years.
Beta-blockers are medications that slow the heart rate and lower blood pressure by blocking adrenaline and other hormones. They have long been a cornerstone of post-heart attack care, prescribed to reduce the risk of a repeat event.
Researchers found that the rate of the main combined outcome—death from any cause, another heart attack, or hospitalization for heart failure—was 7.2 percent in those who stopped taking beta-blockers, compared with 9 percent in those who kept taking them.
Because the group that stopped medication had a lower mortality rate, the findings met criteria for showing that stopping was not worse (non-inferior) than continuing.
“In stable post-heart attack patients without heart failure or weakened pumping function who have been on beta-blockers long term, stopping beta-blockers was not worse than continuing them for major outcomes,” Hahn said.
Ceasing beta-blocker treatment also didn’t lead to worse outcomes for other cardiac conditions, such as new-onset irregular heartbeat, changes in heart function, quality of life, or serious side effects.
Who Can Consider Stopping
Not every heart attack survivor is a candidate for discontinuation. Patients who are the best candidates for stopping beta-blocker treatment, Hahn said, are those who are mostly healthy. These people include those who have survived a heart attack, those who do not have heart failure or left ventricular systolic dysfunction, or those who are experiencing side effects from beta-blocker use such as fatigue, dizziness, slow heart rate, or low blood pressure.
No one should stop on their own. Dr. Carolyn Lam, a cardiologist and cofounder at artificial intelligence-powered cardiac imaging company Us2.ai, and not involved in the study, said that any discontinuation must be medically supervised.
“The dose should be tapered gradually over days to weeks, rather than stopping abruptly, to reduce the risk of rebound increases in heart rate or blood pressure,” Lam told The Epoch Times.
During and after tapering, she said, patients should track a few simple things at home, such as resting heart rate, blood pressure, and any new or worsening symptoms, including chest discomfort, shortness of breath, palpitations, dizziness, or swelling.
Lam recommended that early clinical follow‑up visits be scheduled within the first one to three months to check vital signs, review symptoms, repeat an echocardiogram, and, when appropriate, have an echocardiogram to ensure that heart function remains preserved.
“If blood pressure creeps up, heart rate runs high, angina returns, or arrhythmias emerge after stopping a beta‑blocker, we do not hesitate to restart or adjust therapy,” she said.
Guidelines Expected to Change
The findings are already drawing attention from the wider cardiology community, because current guidelines recommend that patients stay on beta-blockers after a heart attack permanently.
“I am sure that guideline committees around the world will be reshaping their recommendations in light of the new evidence about when to start and when to stop beta-blockers,” Dr. Peter Kowey, cardiologist at the Lankenau Institute for Medical Research and professor of medicine and clinical pharmacology at Thomas Jefferson University, and not involved in the study, told The Epoch Times.
Kowey said he agrees that an individualized approach is appropriate.
“However, we should not lose sight of the significant benefit that accrues with the use of these drugs in patients who need them, especially those with significant left ventricular dysfunction and cardiac arrhythmias,” he said.
Hahn agreed that monitoring remains essential after stopping.
“Blood pressure and heart rate increased modestly after discontinuation in our study,” he said.
Clinicians should also monitor for changes in the physical forces governing blood flow—such as pressure, velocity, and volume within the cardiovascular system—after stopping beta-blockers and “ensure that blood pressure and heart rate remain adequately controlled, adjusting other therapies as needed,” Hahn said.
The study had some limitations. Most participants had been taking beta-blockers for several years before stopping, so it’s unclear whether the findings might not apply to those who have been on the medication for a shorter period or how soon after a heart attack it’s safe to stop.
Women and patients with mildly reduced heart function were underrepresented, and the trial was conducted only in South Korea, so more research is needed before the findings can be applied more broadly.