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

BMC Geriatrics

Research Article

Andreas Zeller¹  Kasper L. Johansen²  Marija Petek Šter³  Victoria Tkachenko⁴  Peter Torzsa⁵  Kathryn Hoffmann⁶  Tuomas H. Koskela⁷  Gerasimovska Kitanovska Biljana⁸  Jacobijn Gussekloo⁹  Margot W. M. de Waal⁹  Rosalinde K. E. Poortvliet⁹  Sandra Gintere^1,10  Rita P. A. Viegas^1,11  Sanda Kreitmayer Peštić^1,12  Donata Kurpas^1,13  Tuz Canan^1,14  Hans Thulesius^1,15  Daiana Bonfim^1,16  Raquel Gómez Bravo^1,17  Yolanda Mueller^1,18  Christiane Muth^1,19  Thomas Rosemann^2,20  Marjolein Verschoor^2,21  Sven Streit^2,21  Nicolas Rodondi^2,22  Christoph Merlo^2,23  Claire Collins^2,24  Rosy Tsopra^2,25  Zuzana Švadlenková^2,26  Hubert Maisoneuve^2,27  Christian D. Mallen^2,28  Athina Tatsioni^2,29  Ferdinando Petrazzuoli^3,30  Martin Sattler^3,31  Shlomo Vinker^3,32  Ngaire Kerse^3,33  Claudia Iftode^3,34  Robert A. Burman^3,35 

[1] Centre for Primary Health Care (uniham-bb), Basel, Switzerland;Danish College of General Practitioners, Copenhagen, Denmark;Department for Family Medicine, Medical faculty, University of Ljubljana, Ljubljana, Slovenia;Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine;Department of Family Medicine, Semmelweis University, Budapest, Hungary;Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria;Department of General Practice, University of Tampere, Tampere, Finland;Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia;Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands;Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University, Riga, Latvia;Family Doctor, Invited Assistant of the Department of Family Medicine, NOVA Medical School, Lisbon, Portugal;Family Medicine Department, Health Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina;Family Medicine Department, Wroclaw Medical University, Wrocław, Poland;Family Medicine Specialist, Kemaliye Town Hospital, Erzincan University, Erzincan, Turkey;Family Medicine, Department of Clinical Sciences, Lund University, Malmö and senior researcher Region Kronoberg, Växjö, Sweden;Hospital Israelita Albert Einstein, São Paulo, Brazil;Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg, Luxembourg;Institute of Family Medicine Lausanne (IUMF), Lausanne, Switzerland;Institute of General Practice, Goethe-University, Frankfurt / Main, Germany;Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland;Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland;Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland;Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;Institute of Primary and Community Care Lucerne (IHAM), Lucerne, Switzerland;Irish College of General Practitioners, Dublin, Ireland;LIMICS, INSERM, U1142, F-75006 Paris, Université Paris 13, Sorbonne Paris Cité, UMR_S 1142, F93000 Bobigny, Sorbonne Universités, UPMC Université Paris 06, UMR_S 1142, F75006 Paris, Paris, France;Leeds Centre for Respiratory Medicine, St James’s University Hospital, Beckett Street, LS9 7TF, Leeds, UK;Ordinace Řepy, s.r.o., Prague, Prague, Czech Republic;Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland;Primary Care and Health Sciences, Keele University, ST5 5BG, Keele, Staffordshire, UK;Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece;SNAMID (National Society of Medical Education in General Practice), Prata Sannita, Italy;Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden;SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg, Luxembourg;Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;School of Population Health, University of Auckland, Auckland, New Zealand;Timis Society of Family Medicine, Sano Med West Private Clinic, Timisoara, Romania;Vennesla Primary Health Care Centre, Bergen, Norway;

关键词: Hypertension;    Oldest-old;    Clinical variation;    General practitioners;    Frailty;    Elderly;   

DOI  :  10.1186/s12877-017-0486-4

 received in 2017-02-08, accepted in 2017-04-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsUsing 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.ResultsThe 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).ConclusionsAcross 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.

【 授权许可】

CC BY   
© The Author(s). 2017