Christian Mallen c.d.mallen@keele.ac.uk
The British Society for Rheumatology Guideline for the Management of Gout
Mallen, Christian; Roddy, Edward
Abstract
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.
Citation
Mallen, C., & Roddy, E. (2017). The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology, 56(7), E1-E20. https://doi.org/10.1093/rheumatology/kex156
Journal Article Type | Article |
---|---|
Acceptance Date | Jun 23, 2017 |
Publication Date | 2017-07 |
Publicly Available Date | May 30, 2023 |
Journal | RHEUMATOLOGY |
Print ISSN | 1462-0324 |
Publisher | Oxford University Press |
Volume | 56 |
Issue | 7 |
Pages | E1-E20 |
DOI | https://doi.org/10.1093/rheumatology/kex156 |
Public URL | https://keele-repository.worktribe.com/output/427070 |
Publisher URL | https://academic.oup.com/rheumatology/article/56/7/e1/3855179 |
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