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Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.
University of Bern, Switzerland.
Leiden University Medical Center, Netherlands.
Vennesla Primary Health Care Centre, Norway.
Irish College of General Practitioners, Ireland.
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2018 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 1, p. 89-98Article in journal (Refereed) Published
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 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.

Place, publisher, year, edition, pages
Taylor & Francis, 2018. Vol. 36, no 1, p. 89-98
Keywords [en]
Oldest-old, cardiovascular disease burden, clinical decision-making, hypertension, life expectancy
National Category
Cardiac and Cardiovascular Systems
Research subject
Natural Science, Medicine
Identifiers
URN: urn:nbn:se:lnu:diva-81314DOI: 10.1080/02813432.2018.1426142PubMedID: 29366388OAI: oai:DiVA.org:lnu-81314DiVA, id: diva2:1298966
Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-04-12Bibliographically approved

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Thulesius, Hans

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CiteExportLink to record
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Citation style
  • apa
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