Dataset Information

Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.

ABSTRACT:

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.

SUBMITTER: Streit S

PROVIDER: S-EPMC5399328 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Publications

Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.

Streit Sven S Verschoor Marjolein M Rodondi Nicolas N Bonfim Daiana D Burman Robert A RA Collins Claire C Biljana Gerasimovska Kitanovska GK Gintere Sandra S Gómez Bravo Raquel R Hoffmann Kathryn K Iftode Claudia C Johansen Kasper L KL Kerse Ngaire N Koskela Tuomas H TH Peštić Sanda Kreitmayer SK Kurpas Donata D Mallen Christian D CD Maisoneuve Hubert H Merlo Christoph C Mueller Yolanda Y Muth Christiane C Šter Marija Petek MP Petrazzuoli Ferdinando F Rosemann Thomas T Sattler Martin M Švadlenková Zuzana Z Tatsioni Athina A Thulesius Hans H Tkachenko Victoria V Torzsa Peter P Tsopra Rosy R Canan Tuz T Viegas Rita P A RPA Vinker Shlomo S de Waal Margot W M MWM Zeller Andreas A Gussekloo Jacobijn J Poortvliet Rosalinde K E RKE

BMC geriatrics 20170420 1

<h4>Background</h4>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-o ...[more]

PMID: 28427345

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Project description:BackgroundStatins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners' (GPs) advice to stop statins in oldest-old patients.ObjectiveTo investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs' advice to stop statins in oldest-old patients.DesignWe invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment.Main measuresCases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs' advice to stop.Key resultsTwo thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45-47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89-90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6-15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5-1.7) and with frailty (ORadj 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5-56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19-42) to 98% (95% CI 96-99).ConclusionsThe absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs' advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs' advice to stop statins.

Dataset Information

Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.

Background

Methods

Results

Conclusions

Publications

Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.

Similar Datasets

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