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A new, long-term study recently released in the New England Journal of Medicine has cardiologists in Western Pennsylvania divided on its potential impacts on the field and how it may impact the treatment of heart attack victims in the future.

This August, the results were released for the REBOOT trial, a long-term study of over 8,500 heart attack patients in Spain and Italy who were administered beta blocker drugs as treatment. Beta blockers have been a standard medication used to manage the immediate aftermath of a heart attack for decades.

“The research back in the ’80s showed that patients who had a heart attack, if they were put on a beta blocker, they seemed to do better than if they weren't,” said Dr. Amish Mehta, director of noninvasive cardiology at AHN Jefferson Hospital in Pittsburgh.

The REBOOT trial, which followed these patients for an average of four years each, found no conclusive evidence that beta blockers have any clinical benefit on any patients who have suffered from an uncomplicated heart attack: a heart attack without any medical complications.

“They followed the patients for an average of almost four years and compared patients who got a beta blocker to patients who didn’t get a beta blocker and it seemed that the patients did equally well,” Mehta said.

The REBOOT study also found women treated with beta blockers had a higher risk of death or hospitalization compared to women who were not, although men treated with beta blockers did not see an increased risk.

“It kind of brought up the possibility that there may be sex differences in how men and women react to beta blockers,” Mehta said.

Mehta said, if the findings of the REBOOT study are to be believed, then the implications for the field of cardiology are serious.

“It really has the potential to affect every hospital, because almost every hospital is graded on how they treat their patients,” Mehta said. “Everybody always wanted to have all of their patients treated with a beta blocker, so now this challenges the whole concept. It may end up being something that we no longer consider a standard treatment at every hospital.”

Mehta added heart attack survivors may, as a result of the REBOOT study, be encouraged to consult with their doctor before being put on beta blocker treatment, instead of having it administered by default.

However, Dr. Angel Flores, cardiologist at Butler Memorial Hospital, doesn’t believe that the REBOOT study has enough weight to cause any drastic and widespread changes to heart attack treatment — at least not yet.

“Unfortunately, any type of news that comes out, the sensational news is the one that gets published,” Flores said. “In the same issue of the New England Journal of Medicine, there was a second trial that was published immediately, back-to-back with REBOOT. And that trial showed the complete opposite.”

That study, called BETAMI–DANBLOCK — a merger of separate studies from Norway and Denmark — found that beta blockers did indeed decrease the risk of death in post-heart attack patients with a pumping capacity of 40% or higher, the same group of patients that was generally targeted by the REBOOT trial.

Flores also noted no major cardiology body has changed its recommendations so far based on the REBOOT findings.

“The American Heart Association, the American College of Cardiology, the Society of Cardiac Angiography, even the European Society of Cardiology... all the large bodies have not changed their recommendations on the basis of this trial,” Flores said.

He believes hospitals should continue to administer beta blockers to most individuals unless there are extenuating circumstances.

“If the patient’s pumping capacity is less than 40%, absolutely, they should receive beta blockers. If the pumping capacity is more than 40%, then what should be done is that the patients should receive beta blockers unless there is a reason not to give it,” Flores said. “One cannot make blanket recommendations because the data is conflicting from the studies that we have received recently.

“At this point, if I have a heart attack, put me on beta blockers, and we’ll talk later.”