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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 and Johansen, Kasper L. , et al. (2018) In Scandinavian Journal of Primary Health Care 36(1). p.89-98
Abstract

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... (More)

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.

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type
Contribution to journal
publication status
published
subject
keywords
cardiovascular disease burden, clinical decision-making, hypertension, life expectancy, Oldest-old
in
Scandinavian Journal of Primary Health Care
volume
36
issue
1
pages
10 pages
publisher
Taylor & Francis
external identifiers
  • scopus:85041138147
  • pmid:29366388
ISSN
0281-3432
DOI
10.1080/02813432.2018.1426142
language
English
LU publication?
yes
id
a2f987ec-a080-4df9-9903-a01246053ef5
date added to LUP
2019-06-17 10:06:20
date last changed
2022-07-27 01:39:43
@article{a2f987ec-a080-4df9-9903-a01246053ef5,
  abstract     = {{<p>Objectives: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (&gt;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 (&lt;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 (&gt;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 &gt;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.</p>}},
  author       = {{Streit, Sven and Gussekloo, Jacobijn and Burman, Robert A. and Collins, Claire and Kitanovska, Biljana Gerasimovska and Gintere, Sandra and Gómez Bravo, Raquel and Hoffmann, Kathryn and Iftode, Claudia and Johansen, Kasper L. and Kerse, Ngaire and Koskela, Tuomas H. and Peštić, Sanda Kreitmayer and Kurpas, Donata and Mallen, Christian D. and Maisonneuve, Hubert and Merlo, Christoph and Mueller, Yolanda and Muth, Christiane and Ornelas, Rafael H. and Šter, Marija Petek and Petrazzuoli, Ferdinando and Rosemann, Thomas and Sattler, Martin and Švadlenková, Zuzana and Tatsioni, Athina and Thulesius, Hans and Tkachenko, Victoria and Torzsa, Peter and Tsopra, Rosy and Tuz, Canan and Verschoor, Marjolein and Viegas, Rita P.A. and Vinker, Shlomo and de Waal, Margot W.M. and Zeller, Andreas and Rodondi, Nicolas and Poortvliet, Rosalinde K.E.}},
  issn         = {{0281-3432}},
  keywords     = {{cardiovascular disease burden; clinical decision-making; hypertension; life expectancy; Oldest-old}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  pages        = {{89--98}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Primary Health Care}},
  title        = {{Burden of cardiovascular disease across 29 countries and GPs’ decision to treat hypertension in oldest-old}},
  url          = {{http://dx.doi.org/10.1080/02813432.2018.1426142}},
  doi          = {{10.1080/02813432.2018.1426142}},
  volume       = {{36}},
  year         = {{2018}},
}