Stable Patients May Safely End Beta-Blockers Post-MI

A South Korean study finds discontinuing beta-blockers a year or more after a heart attack does not worsen outcomes.

Apr. 9, 2026 at 11:48am

Got story updates? Submit your updates here. ›

A translucent, ghostly X-ray image of a human heart, with faint red lines representing the internal structures and blood vessels, conceptually illustrating the cardiovascular system and the impact of beta-blocker medications.An X-ray-like view of the human heart provides insight into the cardiovascular effects of beta-blocker medications for post-heart attack patients.New Orleans Today

A clinical trial in South Korea has found that patients who had a myocardial infarction (MI) can safely stop taking beta-blocker medications to lower blood pressure a year or more after the heart attack, provided they do not have atrial fibrillation, heart failure (HF), or other cardiovascular risk factors.

Why it matters

This is the first randomized study to demonstrate the safety of beta-blocker discontinuation in stable post-MI patients without left ventricular systolic dysfunction or heart failure. It provides important evidence that could help reduce the 'overwhelming' pill burden for these patients.

The details

The SMART-DECISION trial randomized 2,540 patients (mean age 63.2 years, 12.8% women) across 25 sites in South Korea to continue or stop beta-blockers. All patients had had an MI and had been on beta-blockers for at least 1 year, had a left ventricular ejection fraction of at least 40%, and had no diagnosis of HF. The primary composite endpoint of death, MI, or hospitalization for HF did not differ significantly between the two study groups.

  • The trial was conducted from April 2021 to April 2023.
  • The median time from MI to trial randomization was 4.7 years.

The players

Joo Yong Hahn, MD, PhD

Chair of cardiology at Samsung Medical Center in Seoul, South Korea, and lead author of the study.

Nicole Martin Bhave, MD

Cardiologist at the University of Michigan in Ann Arbor, Michigan, who was not involved with the study.

Patrick O'Gara, MD

Cardiology chair at Brigham and Women's Hospital Heart and Vascular Center in Boston, who discussed the trial at the American College of Cardiology (ACC) Scientific Session 2026.

Got photos? Submit your photos here. ›

What they’re saying

“The SMART-DECISION trial is the first randomized study to demonstrate the noninferiority of beta-blocker discontinuation in post-myocardial infarction patients without left ventricular systolic dysfunction or heart failure.”

— Joo Yong Hahn, MD, PhD, Chair of cardiology at Samsung Medical Center

“One of the things that I think about when I see a patient with a first myocardial infarction is the sheer number of pills that we're putting them on. It's overwhelming for them. I think this study demonstrated in a more definitive fashion than the ABYSS study that it is safe for patients with lower ejection fraction and no atrial fibrillation to stop that beta-blocker.”

— Nicole Martin Bhave, MD, Cardiologist at the University of Michigan

“This adds to the growing body of evidence around the routine use of beta-blockers following uncomplicated myocardial infarction in patients who have undergone revascularization and are treated with high-intensity lipid-lowering therapy, antiplatelet therapy, etc.”

— Patrick O'Gara, MD, Cardiology chair at Brigham and Women's Hospital Heart and Vascular Center

What’s next

The SMART-DECISION investigators are conducting an individual patient data meta-analysis combining their data with those from the previously published ABYSS study, which found discontinuation of beta-blockers in a stable post-MI population did not provide an equivalent benefit to continuation.

The takeaway

This study provides important evidence that stable post-MI patients without certain risk factors can safely discontinue beta-blockers, potentially reducing their overwhelming pill burden and improving quality of life, though more research is still needed to confirm these findings.