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Variation in GP dec...
Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.
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- Streit, Sven (author)
- University of Bern, Switzerland
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- Verschoor, Marjolein (author)
- University of Bern, Switzerland
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- Rodondi, Nicolas (author)
- University of Bern, Switzerland;Bern University Hospital, Switzerland
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- Bonfim, Daiana (author)
- Hospital Israelita Albert Einstein, Brazil
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- Burman, Robert A (author)
- Vennesla Primary Health Care Centre, Norway
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- Collins, Claire (author)
- Irish College of General Practitioners, Ireland
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- Biljana, Gerasimovska Kitanovska (author)
- University St. Cyril and Metodius, Macedonia,The Saints Cyril and Methodius University of Skopje
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- Gintere, Sandra (author)
- Riga Stradins University, Latvia
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- Gómez Bravo, Raquel (author)
- University of Luxembourg, Luxembourg
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- Hoffmann, Kathryn (author)
- Medical University of Vienna, Austria
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- Iftode, Claudia (author)
- Sano Med West Private Clinic, Romania,Timis Society of Family Medicine
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- Johansen, Kasper L (author)
- Danish College of General Practitioners, Denmark
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- Kerse, Ngaire (author)
- University of Auckland, New Zealand
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- Koskela, Tuomas H (author)
- University of Tampere, Finland
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- Peštić, Sanda Kreitmayer (author)
- University of Tuzla, Bosnia and Herzegovina
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- Kurpas, Donata (author)
- Wroclaw Medical University, Poland
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- Mallen, Christian D (author)
- Keele University, UK
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- Maisoneuve, Hubert (author)
- University of Geneva, Switzerland,University of Geneva Medical School
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- Merlo, Christoph (author)
- Institute of Primary and Community Care Lucerne (IHAM), Switzerland
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- Mueller, Yolanda (author)
- Institute of Family Medicine Lausanne (IUMF), Switzerland,Lausanne University Hospital
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- Muth, Christiane (author)
- Goethe-University, Germany
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- Šter, Marija Petek (author)
- University of Ljubljana, Slovenia
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- Petrazzuoli, Ferdinando (author)
- Lund University,Lunds universitet,Institutionen för kliniska vetenskaper, Malmö,Medicinska fakulteten,Department of Clinical Sciences, Malmö,Faculty of Medicine
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- Rosemann, Thomas (author)
- University of Zurich, Switzerland,University Hospital of Zurich
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- Sattler, Martin (author)
- Société Scientifique Luxembourgeoise de Médecine Générale SSLMG, Luxembourg
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- Švadlenková, Zuzana (author)
- Ordinace Řepy, Czech Republic
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- Tatsioni, Athina (author)
- University of Ioannina, Greece
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- Thulesius, Hans (author)
- Lund University, Sweden;Region Kronoberg, Sweden,University of Bern
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- Tkachenko, Victoria (author)
- Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Ukraine,Shupyk National Healthcare University of Ukraine
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- Torzsa, Peter (author)
- Semmelweis University, Hungary
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- Tsopra, Rosy (author)
- Univ Paris, France,Sorbonne Paris Nord University,St James's University Hospital,Institut Gustave Roussy
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- Canan, Tuz (author)
- Kemaliye Town Hospital, Turkey;Erzincan University, Turkey
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- Viegas, Rita P A (author)
- NOVA Medical School, Portugal,Family Doctor, Lisboa
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- Vinker, Shlomo (author)
- Tel Aviv University, Israel
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- de Waal, Margot W M (author)
- Leiden University Medical Center, Netherlands
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- Zeller, Andreas (author)
- Basel Centre for Primary Health Care, Switzerland,Centre for Primary Health Care (uniham-bb)
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- Gussekloo, Jacobijn (author)
- Leiden University Medical Center, Netherlands
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- Poortvliet, Rosalinde K E (author)
- Leiden University Medical Center, Netherlands
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(creator_code:org_t)
- 2017-04-20
- 2017
- English.
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In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 17:1, s. 1-7
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https://doi.org/10.1...
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https://bmcgeriatr.b...
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http://dx.doi.org/10... (free)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://lup.lub.lu.s...
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Abstract
Subject headings
Close
- BACKGROUND: In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision.METHODS: Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP.RESULTS: The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs' decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48-0.59; ORs per country 0.11-1.78).CONCLUSIONS: Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Geriatrik (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Geriatrics (hsv//eng)
Keyword
- Clinical variation
- Elderly
- Frailty
- General practitioners
- Hypertension
- Oldest-old
- Medicin
- Medicine
- Clinical variation
- Elderly
- Frailty
- General practitioners
- Hypertension
- Oldest-old
Publication and Content Type
- ref (subject category)
- art (subject category)
Find in a library
To the university's database
- By the author/editor
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Streit, Sven
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Verschoor, Marjo ...
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Rodondi, Nicolas
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Bonfim, Daiana
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Burman, Robert A
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Collins, Claire
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show more...
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Biljana, Gerasim ...
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Gintere, Sandra
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Gómez Bravo, Raq ...
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Hoffmann, Kathry ...
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Iftode, Claudia
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Johansen, Kasper ...
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Kerse, Ngaire
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Koskela, Tuomas ...
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Peštić, Sanda Kr ...
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Kurpas, Donata
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Mallen, Christia ...
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Maisoneuve, Hube ...
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Merlo, Christoph
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Mueller, Yolanda
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Muth, Christiane
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Šter, Marija Pet ...
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Petrazzuoli, Fer ...
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Rosemann, Thomas
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Sattler, Martin
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Švadlenková, Zuz ...
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Tatsioni, Athina
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Thulesius, Hans
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Tkachenko, Victo ...
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Torzsa, Peter
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Tsopra, Rosy
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Canan, Tuz
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Viegas, Rita P A
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Vinker, Shlomo
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de Waal, Margot ...
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Zeller, Andreas
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Gussekloo, Jacob ...
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Poortvliet, Rosa ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Geriatrics
- Articles in the publication
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BMC Geriatrics
- By the university
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Linnaeus University
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Lund University