Reference : Burden of cardiovascular disease across 29 countries and GPs’ decision to treat hyper...
Scientific journals : Article
Human health sciences : Geriatrics
Burden of cardiovascular disease across 29 countries and GPs’ decision to treat hypertension in oldest-old
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 mailto [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. mailto [Leiden University Medical Center, Leiden, The Netherlands > Department of Public Health and Primary Care]
Scandinavian Journal of Primary Health Care
Taylor & Francis
Yes (verified by ORBilu)
[en] Oldest-old ; hypertension ; clinical decision-making
[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
- 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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