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

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Title: Burden of cardiovascular disease across 29 countries and GPs’ decision to treat hypertension in oldest-old.
Authors: Streit, Sven (AUTHOR), Gussekloo, Jacobijn (AUTHOR), Burman, Robert A. (AUTHOR), Collins, Claire (AUTHOR), Kitanovska, Biljana Gerasimovska (AUTHOR), Gintere, Sandra (AUTHOR), Gómez Bravo, Raquel (AUTHOR), Hoffmann, Kathryn (AUTHOR), Iftode, Claudia (AUTHOR), Johansen, Kasper L. (AUTHOR), Kerse, Ngaire (AUTHOR), Koskela, Tuomas H. (AUTHOR), Peštić, Sanda Kreitmayer (AUTHOR), Kurpas, Donata (AUTHOR), Mallen, Christian D. (AUTHOR), Maisonneuve, Hubert (AUTHOR), Merlo, Christoph (AUTHOR), Mueller, Yolanda (AUTHOR), Muth, Christiane (AUTHOR), Ornelas, Rafael H. (AUTHOR)
Source: Scandinavian Journal of Primary Health Care. Mar2018, Vol. 36 Issue 1, p89-98. 10p.
Subjects: Antihypertensive agents, Cardiovascular diseases, Confidence intervals, Ecological research, Hypertension, Life expectancy, Research methodology, Case studies, Myocardial infarction, General practitioners, Population geography, Stroke, Surveys, Decision making in clinical medicine, Quality-adjusted life years, Descriptive statistics, Odds ratio, Old age, Psychology
Geographic Terms: Brazil, Europe, New Zealand
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 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. [ABSTRACT FROM PUBLISHER]
Copyright of Scandinavian Journal of Primary Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: 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. [ABSTRACT FROM PUBLISHER]
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  Data: &lt;i&gt;Copyright of Scandinavian Journal of Primary Health Care is the property of Taylor &amp; Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1080/02813432.2018.1426142
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        Type: general
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      – SubjectFull: Confidence intervals
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