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

S. Streit, J. Gussekloo, RA. Burman, C. Collins, BG. Kitanovska, S. Gintere, R. Gómez Bravo, K. Hoffmann, C. Iftode, KL. Johansen, N. Kerse, TH. Koskela, SK. Peštić, D. Kurpas, CD. Mallen, H. Maisonneuve, C. Merlo, Y. Mueller, C. Muth, RH....

. 2018 ; 36 (1) : 89-98. [pub] 20180125

Language English Country United States

Document type Comparative Study, Journal Article

Persistent link   https://www.medvik.cz/link/bmc18033371

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.

b Department of Clinical Sciences Family Medicine Lund University Malmö Sweden ac Senior Researcher Region Kronoberg Växjö Sweden

b Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands

c Vennesla Primary Health Care Centre Bergen Norway

Department of Family Medicine Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education Kiev Ukraine

e Department of Family Medicine Semmelweis University Budapest Hungary

e Department of Nephrology and Department of Family Medicine University Clinical Centre University St Cyril and Metodius Skopje Macedonia

f Department of Family Medicine Faculty of Medicine Riga Stradiņs University Riga Latvia

f LIMICS INSERM Paris France ag Leeds Centre for Respiratory Medicine St James's University Hospital Leeds UK

Family Medicine Department Wroclaw Medical University Wroclaw Poland

g Institute for Health and Behaviour Research Unit INSIDE University of Luxembourg Luxembourg Luxembourg

h Department of General Practice and Family Medicine Center for Public Health Medical University of Vienna Vienna Austria

h Kemaliye Town Hospital Erzincan University Erzincan Turkey

i Department of Family Medicine NOVA Medical School Lisbon Portugal

i Timis Society of Family Medicine Sano Med West Private Clinic Timisoara Romania

Institute of Primary Health Care University of Bern Bern Switzerland

Institute of Primary Health Care University of Bern Bern Switzerland al Department of General Internal Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland

Irish College of General Practitioners Dublin Ireland

j Danish College of General Practitioners Copenhagen Denmark

j Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

k Centre for Primary Health Care University of Basel Basel Switzerland

k School of Population Health University of Auckland Auckland New Zealand

l Department of General Practice University of Tampere Tampere Finland

m Family Medicine Department Health Center Tuzla Medical School University of Tuzla Tuzla Bosnia and Herzegovina

o Primary Care and Health Sciences Keele University Keele UK

p Primary Care Unit Faculty of Medicine University of Geneva Geneva Switzerland

q Institute of Primary and Community Care Lucerne Lucerne Switzerland

r Institute of Family Medicine Lausanne Lausanne Switzerland

Research Unit for General Medicine and Primary Health Care Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece

s Institute of General Practice Goethe University Frankfurt Main Germany

t Hospital Israelita Albert Einstein São Paulo Brazil

u Department for Family Medicine Medical Faculty University of Ljubljana Ljubljana Slovenia

v SNAMID Caserta Italy w Department of Clinical Sciences Centre for Primary Health Care Research Lund University Malmö Sweden

x Institute of Primary Care University Hospital Zurich University of Zurich Zurich Switzerland

y SSLMG Societé Scientifique Luxembourgois en Medicine generale Luxembourg Luxembourg

z Ordinace Řepy s r o Prague Czech Republic

References provided by Crossref.org

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