Routine Beta-Blockers in Secondary Prevention — Approaching Retirement?

Nearly half a century ago, trials were performed that provided convincing evidence that long-term treatment with beta-blockers can improve outcomes after a myocardial infarction.1-3 These trials included a high proportion of patients with large myocardial infarctions who had a considerably worse prognosis than most patients who are seen today. These early trials were conducted before the advent of modern biomarker-based diagnosis of myocardial infarction, treatment strategies, and therapeutics. As a result, the use of beta-blockers in patients with myocardial infarction and a preserved left ventricular ejection fraction has been questioned — as evidenced by a series of studies that have . . .