Role of patient sex in prescribing long-term beta blockers after myocardial infarction in German-speaking European primary care settings: a cross-sectional online survey using case vignettes.

Objectives To examine whether general practitioners’ (GPs’) reported willingness to deprescribe long-term beta blockers after myocardial infarction with preserved left ventricular function differs by patient sex and to identify factors that influence the decision to deprescribe. Design Cross-sectional online survey using case vignettes differing by patient sex, time since myocardial infarction (3 months, 5 years, 10 years) and presence of side effects. Setting and participants GPs in primary care in Switzerland, Germany and Austria across five study sites. Primary and secondary outcome measures The primary outcome was the proportion of GPs choosing to deprescribe beta blockers in different hypothetical case vignettes. Secondary outcomes included factors associated with expressing willingness to deprescribe in multivariable regression models and reasons for deprescribing. Results 185 GPs (35.7% female (n=66); mean age 50.7 years (SD 10)) completed the questionnaire (average 61.7 per country (59–66 per country)). In the vignettes without side effects, the proportion of patients for whom GPs reported to be willing to deprescribe increased with time since myocardial infarction (3 months: 23% for male patients and 31% for female patients; 5 years: 46.9% for male and 46.0% for female patients; 10 years: 74.5% for male and 73.6% for female patients). In the presence of side effects, willingness to deprescribe increased (3 months: 63% for male and 79% for female patients; 5 years: 75% for male and 84% for female patients; 10 years: 87% for male and 89% for female patients). Time since myocardial infarction (5 years since myocardial infarction: risk ratio (RR) 1.3, 95% CI 1.2 to 1.5; 10 years: RR 1.7, 95% CI 1.6 to 1.9, reference: 3 months), presence of side effects (RR 1.6, 95% CI 1.5 to 1.8; reference: no side effects) and country of practice were associated with deprescribing (Austria: RR 1.1, 95% CI 1.0 to 1.3; Switzerland: RR 1.2, 95% CI 1.1 to 1.4, reference: Germany). Male patient sex was associated with a lower likelihood of deprescribing compared with female sex (RR 0.9, 95% CI 0.8 to 1.0). Frequently cited reasons for deprescribing included quality of life and perceived balance of benefits and harms, with similar reasons reported across male and female patient vignettes. Conclusion Patient sex showed a small association with GPs’ willingness to deprescribe long-term beta blockers, whereas willingness to deprescribe varied substantially across clinical scenarios, particularly with longer time since myocardial infarction and the presence of side effects.