N Engl J Med
ACC 2026: Stopping beta-blockers after MI appears safe in selected patients
Clinical takeaway: In stable patients ≥1 year post-MI with preserved or mildly reduced EF and no heart failure, consider shared decision-making about beta-blocker discontinuation—especially when adverse effects or medication burden are issues—while continuing beta-blockers in patients with HF or reduced EF.
In the randomized, open-label SMART‑DECISION trial, results of which were presented at ACC 2026, investigators studied 2,540 stable patients ≥1 year after MI with LVEF ≥40% and no heart failure. Patients were randomized to discontinue or continue beta-blocker therapy and followed for a median of 3.1 years. Discontinuation was noninferior to continuation for the primary composite endpoint of all-cause death, recurrent MI, or hospitalization for heart failure (7.2% vs 9.0%; hazard ratio, 0.80; 95% confidence interval, 0.57 to 1.13). Rates of individual CV outcomes, afib, LV function changes, quality of life, and serious adverse events were similar between groups.
These findings suggest that routine lifelong beta-blocker therapy may not be necessary in carefully selected, low-risk post-MI patients managed with contemporary secondary prevention.
Source: Choi KH, et al; SMART-DECISION Investigators. (2026, March 30). N Engl J Med. Discontinuation of Beta-Blocker Therapy after Myocardial Infarction