Do I have to take medication for the rest of my life after a heart attack? The 'common knowledge' overturned by a 2,540-patient RCT
Doctor, do I have to take this medicine for the rest of my life?
This is one of the questions I am frequently asked in the outpatient clinic.
One of the medications that patients who have experienced a myocardial infarction (a condition where the heart's blood vessels become blocked) take without fail every day is a 'beta-blocker.' For many years, it has been said that this medication should be taken for life after a heart attack. However, a study published in April 2026 has significantly shaken that common knowledge.
What you will learn in this article
✅ What kind of drug is a beta-blocker (explained simply)
✅ Details of the research results showing it may be 'okay to stop' after a heart attack
✅ Important conditions that do not apply to all patients
✅ Limitations of the study and its impact on future clinical practice
What exactly is a 'beta-blocker'?
Beta-blockers are a type of medication that slightly suppresses the heart's activity. They have the effect of lowering the heart rate and reducing the burden on the heart. Representative examples include 'bisoprolol,' 'metoprolol,' and 'carvedilol.'
After suffering a myocardial infarction, they have been used to prevent recurrence and protect heart function. Evidence that they 'reduce mortality' accumulated in studies from the 1980s and 1990s, and guidelines began to explicitly state that they should be used after a myocardial infarction.
However, the studies from that time used data from an era when treatment technology was not as advanced as it is today. In the modern age where catheter treatment (stent treatment) has become widespread, whether the same results can truly be obtained has been a long-standing question.
2,540 patients divided into a 'discontinuation group' and a 'continuation group' and followed for 3 years
The study introduced here is an RCT (randomized controlled trial) published in April 2026 in the New England Journal of Medicine (NEJM), one of the most prestigious journals in the medical field.
◾️ Subjects: 2,540 patients after myocardial infarction at hospitals in South Korea
◾️ Conditions: Left ventricular ejection fraction (an indicator of heart function) of 40% or higher, no heart failure, and beta-blocker use for at least 1 year
◾️ Method: Randomly divided into a 'beta-blocker discontinuation group' and a 'continuation group,' and followed for an average of 3.1 years
◾️ Evaluation items: Composite endpoint of all-cause mortality, recurrent myocardial infarction, and hospitalization for heart failure
The results were—
Event incidence rate in the discontinuation group: 7.2%
Event incidence rate in the continuation group: 9.0%
(4-year cumulative incidence rate)
In other words, it was not the case that 'stopping is worse.' The conclusion reached was that, statistically, 'stopping is equivalent to continuing (non-inferiority).'
(Choi KH, Kang D, Kim W, et al. New England Journal of Medicine. 2026. PMID: 41910427)
To those of you who thought, 'So, can I stop right now?'
While this study is an important achievement, there are several important conditions.
1. The subjects were patients whose 'heart function is relatively preserved'
The study targeted patients with a left ventricular ejection fraction of 40% or higher. Patients with heart failure who have reduced heart function (those with a low ejection fraction) may benefit more from beta-blockers. For such individuals, these results do not apply.
② Stable patients who have been taking beta-blockers for more than one year
Patients who have just started taking the medication or who have been in an unstable condition recently are excluded.
③ Always consult with your primary physician first
It is absolutely not okay to stop taking it on your own judgment, saying, “The study said it was okay to stop!” Please make a decision together with your primary physician, considering each patient's individual condition, complications, and interactions with other medications.
What I want to tell you honestly as a doctor
I will also clearly explain the limitations of this study.
・A single-country study in South Korea: Caution is required when extrapolating to Japanese data
・Relatively short follow-up period (median 3.1 years): Long-term safety is still unknown
・Limited patient population: Patients with severe cardiac dysfunction or severe cases were not included
・Open-label trial: Since both doctors and patients knew whether the medication was being taken, the placebo effect may have influenced the results
Also, the conclusion that “it is okay to stop” is only true under “specific conditions.” It does not mean that beta-blockers have become completely unnecessary.
Summary
It used to be said that “you should take beta-blockers for the rest of your life after a heart attack.” However, medicine is constantly advancing.
This NEJM study presents new evidence that “for patients who meet certain conditions, stopping beta-blockers does not change the prognosis.”
Perhaps we are entering an era where we can honestly answer patients who ask at the clinic, “Do I have to take this medicine for the rest of my life?”
If you are currently taking beta-blockers after a heart attack, there is no need to stop immediately. However, if you feel that “my physical condition has been stable recently” or “I am concerned about side effects,” please consult your primary physician.
As a doctor, I feel that being able to say “there is a possibility that you can stop” based on evidence is also important for the relationship of trust with patients.
References
Choi KH, Kang D, Kim W, et al. Discontinuation of Beta-Blocker Therapy after Myocardial Infarction. New England Journal of Medicine. 2026. PMID: 41910427
Disclaimer
This article is intended to provide medical information and is not a substitute for individual medical consultation. Please be sure to consult your primary physician regarding decisions about medication.