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Burden of cardiovas...
Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.
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- Streit, Sven (author)
- University of Bern, Switzerland
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- Gussekloo, Jacobijn (author)
- Leiden University Medical Center, Netherlands
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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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- Kitanovska, Biljana Gerasimovska (author)
- University St. Cyril and Metodius, Macedonia,The Saints Cyril and Methodius University of Skopje
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- Gintere, Sandra (author)
- Riga Stradiņs 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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- Maisonneuve, 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), Switzerlan,Lausanne University Hospital
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- Muth, Christiane (author)
- Institute of General Practice Goethe-University, Germany
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- Ornelas, Rafael H (author)
- Hospital Israelita Albert Einstein, Brazil
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- Šter, Marija Petek (author)
- University of Ljubljana, Slovenia
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- Petrazzuoli, Ferdinando (author)
- Lund University,Lunds universitet,Allmänmedicin och samhällsmedicin,Forskargrupper vid Lunds universitet,Family Medicine and Community Medicine,Lund University Research Groups,National Italian Society of Medical Education In General Practice,SNAMID (National Society of Medical Education in General Practice), Italy;Lund University, Sweden
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- Rosemann, Thomas (author)
- University of Zurich, Switzerland,University Hospital of Zurich
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- Sattler, Martin (author)
- SSLMG - Societé Scientifique Luxembourgois en Medicine generale, Luxembourg
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- Švadlenková, Zuzana (author)
- Ordinace Řepy, s.r.o, Prague, Czech Republic
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- Tatsioni, Athina (author)
- University of Ioannina, Greece
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- Thulesius, Hans (author)
- Lund University,Lunds universitet,Allmänmedicin och samhällsmedicin,Forskargrupper vid Lunds universitet,Family Medicine and Community Medicine,Lund University Research Groups,Lund University, Sweden;Region Kronoberg, Sweden
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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)
- LIMICS-INSERM, France;St James's University Hospital, UK,Institut Gustave Roussy
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- Tuz, Canan (author)
- Kemaliye Town Hospital, Turkey;Erzincan University, Turkey
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- Verschoor, Marjolein (author)
- University of Bern, Switzerland
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- Viegas, Rita P A (author)
- NOVA Medical School, Portugal,NOVA University Lisbon
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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)
- University of Basel, Switzerland
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- Rodondi, Nicolas (author)
- University of Bern, Switzerland;Bern University Hospital, Switzerland
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- Poortvliet, Rosalinde K E (author)
- Leiden University Medical Center, Netherlands
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(creator_code:org_t)
- 2018-01-25
- 2018
- English.
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In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 36:1, s. 89-98
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https://doi.org/10.1...
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https://www.tandfonl...
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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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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Oldest-old
- cardiovascular disease burden
- clinical decision-making
- hypertension
- life expectancy
- Medicin
- Medicine
- cardiovascular disease burden
- clinical decision-making
- hypertension
- life expectancy
- Oldest-old
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Streit, Sven
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Gussekloo, Jacob ...
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Burman, Robert A
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Collins, Claire
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Kitanovska, Bilj ...
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Gintere, Sandra
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show more...
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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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Maisonneuve, Hub ...
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Merlo, Christoph
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Mueller, Yolanda
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Muth, Christiane
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Ornelas, Rafael ...
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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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Tuz, Canan
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Verschoor, Marjo ...
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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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Rodondi, Nicolas
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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 ...
- Articles in the publication
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Scandinavian Jou ...
- By the university
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Linnaeus University
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Lund University