Long-term beta blocker prescribing after myocardial infarction in European primary care (PRACTITIONER)
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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. PARTICIPANTS: Practicing GPs recruited through convenience sampling at each site. MAIN MEASURES: 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. KEY RESULTS: 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). CONCLUSIONS: 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.
Source: BMC Family Practice
Authors: Martina Zangger, Katharina Tabea Jungo, Limor Adler, Radost Assenova, Olivera Batic-Mujanovic, Luigi Bracchitta, Christine Brütting, Krzysztof Buczkowski, Jelena Danilenko, Patrick Erber, Ileana Gefaell Larrondo, Oksana Ilkov, Katerina Javorska, Aisling A. Jennings, Tonje R. Johannessen, Tuomas Koskela, Donata Kurpas, Vanja Lazić, Stina Mannheimer, Mahmoud Moussa, Martin Seifert, Deona Taraj, Peter Torzsa, Catarina Viegas Dias, Erika Zelko, Baris Gencer, Sven Streit
Institutions: University of Bern, Brigham and Women's Hospital, Harvard University, Tel Aviv University, Medical University Plovdiv, University of Tuzla, University Clinical Center Tuzla, Martin Luther University Halle-Wittenberg, Nicolaus Copernicus University, Riga Stradiņš University, Karl Landsteiner University of Health Sciences, Instituto de Investigación Sanitaria Gregorio Marañón, Uzhhorod National University, Charles University, University College Cork, University of Oslo, Tampere University, University of Tampere, Wroclaw Medical University, University Hospital Centre Zagreb, University of Gothenburg, Medical University of Vienna, University of Vlora "Ismail Qemali", Semmelweis University, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Johannes Kepler University of Linz, Centre Hospitalier Universitaire Vaudois, University of Lausanne
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,790
OpenAlex ID: W7128443076