29个国家的心血管疾病负担以及全科医生对最年长者高血压治疗的决策
Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.
作者信息
Streit Sven, Gussekloo Jacobijn, Burman Robert A, Collins Claire, Kitanovska Biljana Gerasimovska, Gintere Sandra, Gómez Bravo Raquel, Hoffmann Kathryn, Iftode Claudia, Johansen Kasper L, Kerse Ngaire, Koskela Tuomas H, Peštić Sanda Kreitmayer, Kurpas Donata, Mallen Christian D, Maisonneuve Hubert, Merlo Christoph, Mueller Yolanda, Muth Christiane, Ornelas Rafael H, Šter Marija Petek, Petrazzuoli Ferdinando, Rosemann Thomas, Sattler Martin, Švadlenková Zuzana, Tatsioni Athina, Thulesius Hans, Tkachenko Victoria, Torzsa Peter, Tsopra Rosy, Tuz Canan, Verschoor Marjolein, Viegas Rita P A, Vinker Shlomo, de Waal Margot W M, Zeller Andreas, Rodondi Nicolas, Poortvliet Rosalinde K E
机构信息
a Institute of Primary Health Care (BIHAM), University of Bern , Bern , Switzerland.
b Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
出版信息
Scand J Prim Health Care. 2018 Mar;36(1):89-98. doi: 10.1080/02813432.2018.1426142. Epub 2018 Jan 25.
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.
目的
我们之前发现，各国老年（>80岁）全科医生（GP）治疗高血压的概率差异很大。我们想探究特定国家的心血管疾病（CVD）负担和预期寿命的差异是否可以解释这些差异。
设计
这是一项使用患有不同合并症和血压水平的老年患者病例 vignette 的调查研究。进行了生态多层次模型分析。
设置
来自欧洲全科医学研究网络（EGPRN）国家、巴西和新西兰的全科医生受访者。
受试者
本研究纳入了来自29个国家的2543名全科医生。
主要观察指标
根据对病例 vignette 的回答，全科医生开始或不开始抗高血压治疗的治疗概率；低（<50%开始治疗）或高（≥50%开始治疗）。CVD 负担定义为因缺血性心脏病和/或中风导致的伤残调整生命年（DALY）损失与每个国家总 DALY 损失的比率；60岁时的预期寿命和每个国家的老年人口患病率。
结果
在对所有 vignette 做出回应的1947名全科医生（76%）中，787名（40%）治疗概率得分高，1160名（60%）得分低。CVD 负担高的国家的全科医生治疗概率较高（比值比[OR]3.70；95%置信区间[CI]3.00 - 4.57）；在60岁预期寿命低的国家，CVD 与高治疗概率相关（OR 2.18，95%CI 1.12 - 4.25）；但在预期寿命高的国家则无关联（OR 1.06，95%CI 0.56 - 1.98）。
结论
全科医生对老年患者治疗/不治疗高血压的选择可由特定国家的健康特征差异来解释。CVD 负担高且60岁预期寿命低的国家的全科医生最有可能治疗老年患者的高血压。要点 • 全科医生在决定是否治疗老年（>80岁）患者的高血压时面临临床困境。 • 在这项纳入来自29个国家的1947名全科医生的研究中，我们发现特定国家的高心血管疾病（CVD）负担（即心肌梗死和/或中风）与80岁以上患者较高的全科医生治疗概率相关。 • 然而，这种关联因60岁时特定国家的预期寿命而有所改变。在60岁预期寿命低的国家，全科医生与高治疗概率呈正相关，而在60岁预期寿命高的国家则无关联。 • 这些发现有助于解释在决定是否治疗老年患者高血压方面存在的一些巨大差异。
Zotero 插件