Letter: Beta blocker withdrawal post-MI - the missed dimension of patient symptoms

I commend Rossello et al for their important analysis of the REBOOT trial1. Their findings – that beta blocker (BB) withdrawal in patients with myocardial infarction (MI) and preserved ejection fraction is not associated with an increased risk of recurrent ischaemic events (hazard ratio [HR] 0.98, 95% confidence interval [CI]: 0.82-1.16) – are particularly practice-changing. The significance is underscored in the subgroup of patients already on chronic BB therapy, where randomisation to stop medication was not associated with an increased risk of the composite ischaemic endpoint (HR 0.93, 95% CI: 0.64-1.34). This directly mitigates the long-held clinical fear of a harmful rebound phenomenon.

However, the study’s exclusive focus on hard endpoints risks creating an incomplete definition of “safety”. In clinical practice, the impetus for deprescribing often arises not from a change in guideline indications but from the patient’s lived experience with the medication – reporting intolerable side-effects like fatigue, dizziness, or sexual dysfunction2. The primary goal in these scenarios is to improve quality of life, a dimension on which the REBOOT analysis, while reassuring on ischaemic risk, is necessarily...