Prescriptions of long-term beta blockers after myocardial infarction in European primary care settings (PRACTITIONER study) – a case vignette study with general practitioners

Martina Zangger, Katharina T. 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 Jennings, Tonje R. Johannessen, Tuomas Koskela, Donata Kurpas, Vanja Lazić, Stina Mannheimer, Mahmoud Moussa, Martin Seifert, Deona Taraj, Péter Torzsa, Catarina Viegas Dias, Erika Zelko, Baris Gencer, Sven Streit

Keywords: deprescribing, beta blocker, myocardial infarction, primary care

Background:

There is uncertainty about the chronic use of betablockers after acute myocardial infarction (AMI) with preserved ventricular function. General practitioners’ (GPs) perspectives offer insights into beta blocker prescribing in daily practice amidst evolving evidence.

Research questions:

How do GPs prescribe beta blockers in patients post-AMI, how do prescribing patterns vary across Europe, and what factors influence decisions to prescribe or deprescribe beta blockers?

Method:

We conducted a cross-sectional online survey of GPs in Europe, using case vignettes to explore their decisions about beta blocker deprescribing post-AMI. Vignettes varied in time since AMI, side effects, and comorbidities of a hypothetical patient. Sociodemographic and professional characteristics of GPs were also collected. Each research site collected a minimum of 20 responses (mean=30.2). We analyzed adjusted associations between deprescribing decisions and GP characteristics using a multivariable generalized estimating equations model, accounting for clustering at the GP and country levels, and descriptively assessed factors influencing these decisions.

Results:

A total of 602 GPs from 24 research sites in 20 countries completed the survey. GPs’ mean age was 45.2 years (SD 11.8), 60.1% were female, the mean work experience was 14.5 years (SD 10.8). Overall, 89.2% of GPs opted to deprescribe beta blockers in at least one vignette. Time since AMI (5 years: adjusted RR 1.28, 95% CI 1.21–1.36; 10 years: adjusted RR 1.78, 95% CI 1.66–1.90, vs. 3 months) and side effects (adjusted RR 1.76, 95% CI 1.66–1.88) increased deprescribing likelihood, while greater experience decreased it (adjusted RR 0.86, 95% CI 0.77–0.95 for the most experienced vs. least experienced).

Conclusions:

In hypothetical scenarios, GPs are willing to deprescribe beta blockers post-AMI, factoring in patient-specific elements such as time since AMI and the presence of side effects. These findings suggest that while the debate around beta blocker continuation persists, GPs are already translating discontinuation practices into practice.

Points for discussion:

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