Continue or discontinue beta-blockers after myocardial infarction? – a case vignette study in Europe

Martina Zangger, Katharina Tabea Jungo, Baris Gencer, Sven Streit

Keywords: beta-blockers, myocardial infarction, prescribing variation

Background:

The optimal long-term management of myocardial infarction with preserved left ventricular ejection fraction with respect to beta-blocker prescription is controversial. Recommendations for prescribing beta-blockers are based on studies conducted before the introduction of reperfusion therapy. Today, the question arises whether beta-blockers are still as beneficial in those without heart failure or left ventricular dysfunction. Guidelines vary in the strength of recommendation for prescribing beta-blockers in these situations due to the lack of recent trials. However, unclear guidelines increase variation in clinical practice and quality of care. Our aim is to examine the reasons why general practitioners (GPs) prescribe or deprescribe beta-blockers in this clinical situation, where there is no clear evidence, and to assess the factors that might influence their decisions.

Research questions:

How do GPs’ long-term beta-blocker prescriptions after myocardial infarction with preserved left ventricular ejection fraction vary across European countries and which factors influence their decision to prescribe or deprescribe beta-blockers in a situation in which the evidence is unclear?

Method:

This will be a cross-sectional online case vignette study with GPs across different European countries. We will assess GP characteristics, their prescribing behaviors related to beta-blockers, and their decisions to deprescribe or reduce dosages of beta-blockers in case vignettes that differ in terms of patient age, history of myocardial infarction, comorbidities, and side effects.

Results:

N/A

Conclusions:

This study will shed more light on (de)prescribing decisions in a situation of uncertain evidence. We will investigate the extent of beta-blocker prescription variation and the reasons behind the (de)prescribing decisions. Future studies could focus on explanations for these differences to ensure high-quality levels of care. The reasons for (dis)continuation of beta-blocker therapy found in this study could also apply to other situations with unclear evidence. Also, they could be considered in future guideline recommendations to include GPs' perspective.

Points for discussion:

Would you be interested in participating in this study?

What kind of case vignette would you see as relevant?

What are your best practices about (de)prescribing beta-blockers in this situation?

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