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

TL;DR

Most general practitioners in Europe are willing to stop beta blockers after a heart attack if the patient's heart function is normal, especially over time or with side effects.

Contribution

This study provides new insights into how GPs in Europe apply evolving evidence to deprescribe beta blockers post-heart attack.

Findings

89.2% of GPs deprescribed beta blockers in at least one case scenario.

Deprescribing was more likely after 5 or 10 years post-heart attack and with side effects.

More experienced GPs were less likely to deprescribe beta blockers.

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.

The online version contains supplementary material available at 10.1186/s12875-026-03208-6.

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