Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.
Scand J Prim Health Care
; 36(1): 89-98, 2018 Mar.
Article
em En
| MEDLINE
| ID: mdl-29366388
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 OUTCOMEMEASURES:
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Padrões de Prática Médica
/
Doenças Cardiovasculares
/
Expectativa de Vida
/
Tomada de Decisões
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Clínicos Gerais
/
Hipertensão
/
Anti-Hipertensivos
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged80
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Female
/
Humans
/
Male
País/Região como assunto:
America do sul
/
Brasil
/
Europa
/
Oceania
Idioma:
En
Revista:
Scand J Prim Health Care
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
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