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Background <p>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.</p> Objective <p>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.</p> Design <p>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.</p> Participants <p>Practicing GPs recruited through convenience sampling at each site.</p> Main measures <p>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.</p> Key results <p>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).</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月9日

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  • 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

摘要

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.