Article (Scientific journals)
Burden of cardiovascular disease across 29 countries and GPs’ decision to treat hypertension in oldest-old
Streit, Sven; Gussekloo, Jacobijn; Burman, Robert A. et al.
2018In Scandinavian Journal of Primary Health Care
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Keywords :
Oldest-old; hypertension; clinical decision-making
Abstract :
[en] 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
Disciplines :
Author, co-author :
Streit, Sven;  University of Bern, Bern, Switzerland > Institute of Primary Health Care (BIHAM)
Gussekloo, Jacobijn;  Leiden University Medical Center, Leiden, The Netherlands > Department of Public Health and Primary Care
Burman, Robert A.;  Vennesla Primary Health Care Centre, Bergen, Norway
Collins, Claire;  Irish College of General Practitioners, Dublin, Ireland
Gerasimovska Kitanovska, Biljana;  University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia > Department of Nephrology and Department of Family Medicine
Gintere, Sandra;  Faculty of Medicine, Riga Stradin¸s University, Riga, Latvia > Department of Family Medicine
Gomez Bravo, Raquel ;  University of Luxembourg > Faculty of Language and Literature, Humanities, Arts and Education (FLSHASE) > Integrative Research Unit: Social and Individual Development (INSIDE)
Hoffmann, Kathryn;  Medical University of Vienna, Vienna, Austria > Department of General Practice and Family Medicine, Center for Public Health
Iftode, Claudia;  Timis Society of Family Medicine, Sano Med West Private Clinic, Timisoara, Romania
Johansen, Kasper L.;  Danish College of General Practitioners, Copenhagen, Denmark
Kerse, Ngaire;  University of Auckland, Auckland, New Zealand ; School of Population Health
Koskela, Tuomas H.;  University of Tampere, Tampere, Finland > Department of General Practice
Kreitmayer Pe"sti!c, Sanda;  University of Tuzla, Tuzla, Bosnia and Herzegovina > Family Medicine Department, Health Center Tuzla, Medical School
Kurpas, Donata;  Wroclaw Medical University, Wroclaw, Poland > Family Medicine Department,
Mallen, Christian D.;  Keele University, Keele, UK > Primary Care and Health Sciences
Maisonneuve, Hubert;  Faculty of Medicine, University of Geneva, Geneva, Switzerland > Primary Care Unit
Merlo, Christoph;  Institute of Primary and Community Care Lucerne (IHAM), Lucerne, Switzerland
Mueller, Yolanda;  Institute of Family Medicine Lausanne (IUMF), Lausanne, Switzerland
Muth, Christiane;  Institute of General Practice Goethe-University, Frankfurt/Main, Germany
Ornelas, Rafael H.;  Hospital Israelita Albert Einstein, S~ao Paulo, Brazil
Petek Ster, Marija;  Medical Faculty, University of Ljubljana, Ljubljana, Slovenia > Department for Family Medicine
Petrazzuoli, Ferdinando;  Lund University, Malmo, Sweden > Department of Clinical Sciences, Centre for Primary Health Care Research,
Rosemann, Thomas;  University of Zurich, Zurich, Switzerland > Institute of Primary Care, University Hospital Zurich
Sattler, Martin;  SSLMG, Societe Scientifique Luxembourgois en Medicine generale, Luxembourg, Luxembourg
Svadlenkova, Zuzana;  Ordinace Repy, s.r.o, Prague, Czech Republic
Tatsioni, Athina;  University of Ioannina, Ioannina, Greece > Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences,
Thulesius, Hans;  Lund University, Malmo, Sweden > Department of Clinical Sciences, Family Medicine
Tkachenko, Victoria;  Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine > Department of Family Medicine
Torzsa, Peter;  Semmelweis University, Budapest, Hungary > Department of Family Medicine
Tsopra, Rosy;  St James’s University Hospital, Leeds, UK > Leeds Centre for Respiratory Medicine
Tuz, Canan;  Kemaliye Town Hospital, Erzincan University, Erzincan, Turkey
Verschoor, Marjolein;  University of Bern, Bern, Switzerland > Institute of Primary Health Care (BIHAM)
Viegas, Rita P. A.;  NOVA Medical School, Lisbon, Portugal > Department of Family Medicine
Vinker, Shlomo;  Tel Aviv University, Tel Aviv, Israel > Sackler Faculty of Medicine
de Waal, Margot W. M.;  Leiden University Medical Center, Leiden, The Netherlands > Department of Public Health and Primary Care
Zeller, Andreas;  University of Basel, Basel, Switzerland > Centre for Primary Health Care (uniham-bb),
Rodondi, Nicolas;  University of Bern, Bern, Switzerland > Department of General Internal Medicine, Inselspital, Bern University Hospital
Poortvliet, Rosalinde K. E.;  Leiden University Medical Center, Leiden, The Netherlands > Department of Public Health and Primary Care
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Title :
Burden of cardiovascular disease across 29 countries and GPs’ decision to treat hypertension in oldest-old
Publication date :
25 January 2018
Journal title :
Scandinavian Journal of Primary Health Care
Publisher :
Taylor & Francis, Oslo, Norway
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
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.
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