Evidence map›Paper›PMID 29366388›Full record

ArticleScandinavian journal of primary health care2018

Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.

Sven Streit, Jacobijn Gussekloo, Robert A Burman, Claire Collins, Biljana Gerasimovska Kitanovska, Sandra Gintere, Raquel Gómez Bravo, Kathryn Hoffmann, Claudia Iftode, Kasper L Johansen and 28 more

Open access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Scandinavian journal of primary health care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
1.7field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 17 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

38 authors at 20 institutions in 23 countries.

Sven Streita Institute of Primary Health Care (BIHAM), University of Bern , Bern , Switzerland.
Jacobijn Gussekloob Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
Robert A Burmanc Vennesla Primary Health Care Centre , Bergen , Norway.
Claire Collinsd Irish College of General Practitioners , Dublin , Ireland.
Biljana Gerasimovska Kitanovskae Department of Nephrology and Department of Family Medicine , University Clinical Centre, University St. Cyril and Metodius , Skopje , Macedonia.
Sandra Ginteref Department of Family Medicine, Faculty of Medicine , Riga Stradiņs University , Riga , Latvia.
Raquel Gómez Bravog Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg , Luxembourg, Luxembourg.
Kathryn Hoffmannh Department of General Practice and Family Medicine , Center for Public Health, Medical University of Vienna , Vienna , Austria.
Claudia Iftodei Timis Society of Family Medicine, Sano Med West Private Clinic , Timisoara , Romania.
Kasper L Johansenj Danish College of General Practitioners , Copenhagen , Denmark.
Ngaire Kersek School of Population Health , University of Auckland , Auckland , New Zealand.
Tuomas H Koskelal Department of General Practice , University of Tampere , Tampere , Finland.
Sanda Kreitmayer Peštićm Family Medicine Department , Health Center Tuzla, Medical School, University of Tuzla, Tuzla , Bosnia and Herzegovina.
Donata Kurpasn Family Medicine Department , Wroclaw Medical University , Wroclaw , Poland.
Christian D Malleno Primary Care and Health Sciences , Keele University , Keele , UK.
Hubert Maisonneuvep Primary Care Unit, Faculty of Medicine , University of Geneva , Geneva , Switzerland.
Christoph Merloq Institute of Primary and Community Care Lucerne (IHAM) , Lucerne , Switzerland.
Yolanda Muellerr Institute of Family Medicine Lausanne (IUMF) , Lausanne , Switzerland.
Christiane Muths Institute of General Practice Goethe-University , Frankfurt/Main , Germany.
Rafael H Ornelast Hospital Israelita Albert Einstein , São Paulo , Brazil.
Marija Petek Šteru Department for Family Medicine, Medical Faculty , University of Ljubljana , Ljubljana , Slovenia.
Ferdinando Petrazzuoliv SNAMID (National Society of Medical Education in General Practice) , Caserta , Italy.
Thomas Rosemannx Institute of Primary Care, University Hospital Zurich, University of Zurich , Zurich , Switzerland.
Martin Sattlery SSLMG, Societé Scientifique Luxembourgois en Medicine generale , Luxembourg , Luxembourg.
Zuzana Švadlenkováz Ordinace Řepy, s.r.o , Prague , Czech Republic.
Athina Tatsioniaa Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences , University of Ioannina , Ioannina , Greece.
Hans Thulesiusab Department of Clinical Sciences, Family Medicine , Lund University, Malmö , Sweden.
Victoria Tkachenkoad Department of Family Medicine , Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education , Kiev , Ukraine.
Peter Torzsaae Department of Family Medicine , Semmelweis University , Budapest , Hungary.
Rosy Tsopraaf LIMICS, INSERM , Paris , France.
Canan Tuzah Kemaliye Town Hospital, Erzincan University , Erzincan , Turkey.
Marjolein Verschoora Institute of Primary Health Care (BIHAM), University of Bern , Bern , Switzerland.
Rita P A Viegasai Department of Family Medicine , NOVA Medical School , Lisbon, Portugal.
Shlomo Vinkeraj Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
Margot W M de Waalb Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
Andreas Zellerak Centre for Primary Health Care (uniham-bb), University of Basel , Basel , Switzerland.
Nicolas Rodondia Institute of Primary Health Care (BIHAM), University of Bern , Bern , Switzerland.
Rosalinde K E Poortvlietb Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
Leiden University Medical Center · NLUniversity of Bern · CHLund University · SEDanish College of General Practitioners · DKErzincan University · TRGoethe University Frankfurt · DEHospital Israelita Albert Einstein · BRKeele University · GBMedical University of Vienna · ATRiga Stradiņš University · LVSemmelweis University · HUShupyk National Healthcare University of Ukraine · UASt James's University Hospital · GBTampere University · FITel Aviv University · ILUniversidade Nova de Lisboa · PTUniversity Clinical Centre · PLUniversity of Auckland · NZUniversity of Basel · CHUniversity of Geneva · CH

Funding

Department of Health RP_2014-04-026
6 · The paper itself

Abstract

objectivesWe 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.

designThis 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.

settingGP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. SUBJECTS: This study included 2543 GPs from 29 countries.

main outcome measuresGP 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.

resultsOf 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).

conclusionsGPs' 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.

Indexed as

Decision MakingGeneral PractitionersLife ExpectancyPractice Patterns, Physicians'Aged, 80 and overAge FactorsAntihypertensive AgentsBlood PressureBrazilCardiovascular DiseasesComorbidityCross-Cultural ComparisonDemographyEuropeFemaleGeneral PracticeAntihypertensive Agentscardiovascular disease burdenclinical decision-makinghypertensionlife expectancyOldest-old

Identifiers

PMID29366388
PMCPMC5901445
OpenAlexW2786107878

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.