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

作者：Streit Sven; Gussekloo Jacobijn; Burman Robert A; Collins Claire; Kitanovska Biljana Gerasimovska; Gintere Sandra; Bravo Raquel Gomez; Hoffmann Kathryn; Iftode Claudia; Johansen Kasper L; Kerse Ngaire; Koskela Tuomas H; Pestic Sanda Kreitmayer; Kurpas Donata; Mallen Christian D; Maisonneuve Hubert; Merlo Christoph; Mueller Yolanda; Muth Christiane; Ornelas Rafael H; Ster Marija Petek; Petrazzuoli Ferdinando; Rosemann Thomas; Sattler Martin; Svadlenkova Zuzana

来源：Scandinavian Journal of Primary Health Care, 2018, 36(1): 89-98.

DOI：10.1080/02813432.2018.1426142

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

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.

• 出版日期2018