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Beta-blockers after a heart attack may not be the long-term lifesaver we thought. A large Greek registry study found that prescribing beta-blockers at discharge after acute coronary syndrome (ACS) offered only a modest early survival benefit — and it largely faded by five years. The clearest signal was in patients with significantly reduced heart function, but even that wasn't sustained.
Beta-blockers have long been a go-to prescription after a heart attack, but a new study is raising questions about their long-term value. Researchers analyzed data from over 6,000 ACS patients in a Greek multicentre registry (2010–2023) and found that while beta-blockers at discharge were associated with a modest early survival benefit, that advantage largely disappeared by the five-year mark.
The most meaningful signal was seen in patients with reduced left ventricular ejection fraction (LVEF ≤ 40%) — those with the weakest heart function — where a 5.5% absolute survival difference was observed at one year. But even in this group, the benefit wasn't clearly sustained over five years. Patients with mildly reduced or preserved heart function showed little to no significant survival difference at either time point.
Key Takeaways:
Why it matters: These findings challenge the routine blanket use of beta-blockers in all ACS patients post-discharge, suggesting clinicians may need to be more selective — particularly prioritizing those with impaired heart function — rather than applying a one-size-fits-all approach.
