Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.

Streit, Sven; Gussekloo, Jacobijn; Burman, Robert A; Collins, Claire; Kitanovska, Biljana Gerasimovska; Gintere, Sandra; Gómez Bravo, Raquel; Hoffmann, Kathryn; Iftode, Claudia; Johansen, Kasper L; Kerse, Ngaire; Koskela, Tuomas H; Peštić, Sanda Kreitmayer; Kurpas, Donata; Mallen, Christian D; Maisonneuve, Hubert; Merlo, Christoph; Mueller, Yolanda; Muth, Christiane; Ornelas, Rafael H; ... (2018). Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old. Scandinavian Journal of Primary Health Care, 36(1), pp. 89-98. 10.1080/02813432.2018.1426142

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OBJECTIVES We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. DESIGN This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. SETTING GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. SUBJECTS This study included 2543 GPs from 29 countries. MAIN OUTCOME MEASURES GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. RESULTS Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98). CONCLUSIONS GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points  • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age).  • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years.  • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60.  • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Streit, Sven and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1502-7724

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

30 Jan 2018 15:49

Last Modified:

27 Oct 2019 19:55

Publisher DOI:

10.1080/02813432.2018.1426142

PubMed ID:

29366388

Uncontrolled Keywords:

Oldest-old cardiovascular disease burden clinical decision-making hypertension life expectancy

BORIS DOI:

10.7892/boris.110550

URI:

https://boris.unibe.ch/id/eprint/110550

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