TY - JOUR
T1 - Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries
AU - Streit, Sven
AU - Verschoor, Marjolein
AU - Rodondi, Nicolas
AU - Bonfim, Daiana
AU - Burman, Robert A.
AU - Collins, Claire
AU - Biljana, Gerasimovska Kitanovska
AU - Gintere, Sandra
AU - Gómez Bravo, Raquel
AU - Hoffmann, Kathryn
AU - Iftode, Claudia
AU - Johansen, Kasper L.
AU - Kerse, Ngaire
AU - Koskela, Tuomas H.
AU - Peštić, Sanda Kreitmayer
AU - Kurpas, Donata
AU - Mallen, Christian D.
AU - Maisoneuve, Hubert
AU - Merlo, Christoph
AU - Mueller, Yolanda
AU - Muth, Christiane
AU - Šter, Marija Petek
AU - Petrazzuoli, Ferdinando
AU - Rosemann, Thomas
AU - Sattler, Martin
AU - Švadlenková, Zuzana
AU - Tatsioni, Athina
AU - Thulesius, Hans
AU - Tkachenko, Victoria
AU - Torzsa, Peter
AU - Tsopra, Rosy
AU - Canan, Tuz
AU - Viegas, Rita P.A.
AU - Vinker, Shlomo
AU - De Waal, Margot W.M.
AU - Zeller, Andreas
AU - Gussekloo, Jacobijn
AU - Poortvliet, Rosalinde K.E.
PY - 2017/4/20
Y1 - 2017/4/20
N2 - 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.
AB - 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.
KW - Clinical variation
KW - Elderly
KW - Frailty
KW - General practitioners
KW - Hypertension
KW - Oldest-old
UR - http://www.scopus.com/inward/record.url?scp=85018500043&partnerID=8YFLogxK
U2 - 10.1186/s12877-017-0486-4
DO - 10.1186/s12877-017-0486-4
M3 - Article
C2 - 28427345
AN - SCOPUS:85018500043
SN - 1471-2318
VL - 17
SP - 1
EP - 7
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
ER -
