Beta-blockers have been a basic drug in secondary prevention after myocardial infarction for decades, but their benefit depends on the patient's ejection fraction.[1][4] In patients with a reduced ejection fraction (below 40%), the effectiveness of beta-blockers has been clearly proven, and their long-term administration reduces mortality by up to 23 percent.[1][4] In patients with preserved ejection fraction (above 50%), the results are less clear - new studies from 2024 show that the benefit of beta-blockers may be more modest in the era of modern revascularization and current treatment.[2][4] A French study of approximately 3,700 patients found that after three years of follow-up, the incidence of death, heart attack, stroke, or cardiovascular hospitalization was lower in patients taking beta-blockers (21% versus 24%), largely due to fewer hospitalizations.[2] However, discontinuation of chronic beta-blocker therapy at least one year after an uncomplicated myocardial infarction with preserved ejection fraction does not meet non-inferiority criteria and has been associated with a higher rate of adverse events.[4] Current recommendations clearly define the role of beta-blockers in patients with an ejection fraction below 40%, while in patients with a preserved ejection fraction their role remains subject to further refinement based on new data.[1]