Long-term beta blocker prescribing after myocardial infarction in European primary care (PRACTITIONER)

The long-term use of beta blockers after myocardial infarction in patients with preserved ventricular function is debated. General practitioners (GPs) often decide whether to continue or discontinue long-term medications, yet little is known about how they apply evolving evidence to clinical prescribing decisions. To assess whether GPs are willing to deprescribe beta blockers post myocardial infarction with preserved left ventricular function and to identify factors associated with deprescribing decisions. Cross-sectional online survey using case vignettes, conducted between July 2023 and October 2024 in primary care settings in 24 sites across 20 European countries. Practicing GPs recruited through convenience sampling at each site. The primary outcome was whether the GP chose to deprescribe beta blockers in the vignettes. Adjusted risk ratios for the association between GP characteristics and the decision to deprescribe were estimated using Poisson regression with generalized estimating equations and robust standard errors, accounting for clustering at the GP and country level. 604 GPs participated in the survey (median [IQR] age, 44.0 [35.0-54.8] years; 364 [60.3%] female), 89.2% deprescribed beta blockers in at least one vignette. The likelihood of deprescribing increased with time since myocardial infarction (adjusted risk ratio [RR] = 1.28; 95% CI 1.21–1.36 after 5 years; RR = 1.78; 95% CI 1.66–1.90 after 10 years vs. 3 months) and with side effects (RR = 1.76; 95% CI 1.66–1.88). More years of clinical experience were associated with a lower likelihood of deprescribing (RR = 0.86; 95% CI 0.77–0.95 for most vs. least experienced). In this cross-national vignette study, most GPs were willing to deprescribe beta blockers after myocardial infarction in patients with preserved left ventricular function, particularly when time had passed and side effects were present. These findings suggest that GPs are open to applying evolving evidence on beta blocker discontinuation in clinical care.

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Publication Details

Journal
BMC Primary Care
Published
2026-02-09
DOI
https://doi.org/10.1186/s12875-026-03208-6
Primary Topic
Acute Myocardial Infarction Research
Type
article
Field-Weighted Citation Impact
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article

Long-term beta blocker prescribing after myocardial infarction in European primary care (PRACTITIONER)

Martina Zangger, Vanja Lazić, Donata Kurpas, Christine Brütting et al.
BMC Primary Care
Acute Myocardial Infarction Research
article

Long-term beta blocker prescribing after myocardial infarction in European primary care (PRACTITIONER)

Martina Zangger, Vanja Lazić, Donata Kurpas, Christine Brütting, Kateřina Javorská, Stina Mannheimer, Martin Seifert, Gencer Baris, Ileana Gefaell Larrondo, Aisling Jennings, Mahmoud Moussa, Erika Zelko, Tonje R. Johannessen, Luigi Maria Bracchitta, Patrick Erber, Krzysztof Buczkowski, Olivera Batic-Mujanovic, Jelena Danilenko, Limor Adler, Katharina Tabea Jungo, Oksana Ilkov, Sven Streit, Deona Taraj, Tuomas Koskela, Peter Torzsa, Radost Assenova
article en

Abstract

The long-term use of beta blockers after myocardial infarction in patients with preserved ventricular function is debated. General practitioners (GPs) often decide whether to continue or discontinue long-term medications, yet little is known about how they apply evolving evidence to clinical prescribing decisions. To assess whether GPs are willing to deprescribe beta blockers post myocardial infarction with preserved left ventricular function and to identify factors associated with deprescribing decisions. Cross-sectional online survey using case vignettes, conducted between July 2023 and October 2024 in primary care settings in 24 sites across 20 European countries. Practicing GPs recruited through convenience sampling at each site. The primary outcome was whether the GP chose to deprescribe beta blockers in the vignettes. Adjusted risk ratios for the association between GP characteristics and the decision to deprescribe were estimated using Poisson regression with generalized estimating equations and robust standard errors, accounting for clustering at the GP and country level. 604 GPs participated in the survey (median [IQR] age, 44.0 [35.0-54.8] years; 364 [60.3%] female), 89.2% deprescribed beta blockers in at least one vignette. The likelihood of deprescribing increased with time since myocardial infarction (adjusted risk ratio [RR] = 1.28; 95% CI 1.21–1.36 after 5 years; RR = 1.78; 95% CI 1.66–1.90 after 10 years vs. 3 months) and with side effects (RR = 1.76; 95% CI 1.66–1.88). More years of clinical experience were associated with a lower likelihood of deprescribing (RR = 0.86; 95% CI 0.77–0.95 for most vs. least experienced). In this cross-national vignette study, most GPs were willing to deprescribe beta blockers after myocardial infarction in patients with preserved left ventricular function, particularly when time had passed and side effects were present. These findings suggest that GPs are open to applying evolving evidence on beta blocker discontinuation in clinical care.

BMC Primary CareVol. 27(1)
Semmelweis University (HU), University of Bern (CH), Johannes Kepler University of Linz (AT), Brigham and Women's Hospital (US), Bern University of Applied Sciences (CH), University Hospital Centre Zagreb (HR), University of Tuzla (BA), Tel Aviv University (IL), Tampere University (FI), University of Oslo (NO), Charles University (CZ), University College Cork (IE), Medical University Plovdiv (BG), Hospital General Universitario Gregorio Marañón (ES), Nicolaus Copernicus University (PL), University of Vlora "Ismail Qemali" (AL), Wroclaw Medical University (PL), Pirkanmaa Hospital District (FI), Madrid Health Service (ES), Riga Stradiņš University (LV), University Hospital Hradec Králové (CZ), University Clinical Center Tuzla (BA), Karl Landsteiner University of Health Sciences (AT), Metropolitana Milanese (Italy) (IT), Public Risk Management Association (US), Martin Luther University Halle-Wittenberg (DE), University of Hradec Králové (CZ), Medical University of Vienna (AT), Uzhhorod National University (UA), Universidade Nova de Lisboa (PT), University of Gothenburg (SE), University of Lausanne (CH)
Openalex Percentile: Top 63%
Acute Myocardial Infarction Research
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