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

Sven Streit, Jacobijn Gussekloo, Robert A. Burman, Claire Collins, Biljana Gerasimovska Kitanovska, Sandra Gintere, Raquel Gómez Bravo, Kathryn Hoffmann, Claudia Iftode, Kasper L. Johansen, Ngaire Kerse, Tuomas H. Koskela, Sanda Kreitmayer Peštić, Donata Kurpas, Christian D. Mallen, Hubert Maisonneuve, Christoph Merlo, Yolanda Mueller, Christiane Muth, Rafael H. OrnelasMarija Petek Šter, Ferdinando Petrazzuoli, Thomas Rosemann, Martin Sattler, Zuzana Švadlenková, Athina Tatsioni, Hans Thulesius, Victoria Tkachenko, Peter Torzsa, Rosy Tsopra, Canan Tuz, Marjolein Verschoor, Rita P.A. Viegas, Shlomo Vinker, Margot W.M. de Waal, Andreas Zeller, Nicolas Rodondi, Rosalinde K.E. Poortvliet

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)89-98
Number of pages10
JournalScandinavian Journal of Primary Health Care
Volume36
Issue number1
DOIs
Publication statusPublished - 2 Jan 2018

Keywords

  • cardiovascular disease burden
  • clinical decision-making
  • hypertension
  • life expectancy
  • Oldest-old

Field of Science

  • 3.3 Health sciences

Publication Type

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database

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