Perspectives of general practitioners towards evaluation and treatment of cardiovascular diseases among older people

Abstract

INTRODUCTION: Risk of cardiovascular disease (CVD) events increases with age. With treatment, individuals with highest risk accrue greater absolute risk reduction. New Zealand’s CVD guidelines provide no upper age limit for risk assessment. Guidance for treating those over 75 years is limited. Little is known about GPs’ attitudes regarding assessing and managing cardiovascular risk among older people. METHODS: A 39-item questionnaire including three cases representing various risk was developed and administered to 500 GPs randomly selected from a registry. RESULTS: Of the GPs, 379 were eligible; 86 (22%) responded to the questionnaire. Most were male (57%), between 40 and 59 years of age (74%), of European ethnicity (57%), had a medical degree from NZ (60%), and had been practising for at least 10 years (98%). Respondents were less likely to assess risk with increasing patient age and more likely to manage risk according to individual risk factors, rather than absolute risk. Marked variation occurred in intent to assess risk for a patient aged 78 years, according to living environment, co-morbidity, and functional status. In general, respondents indicated that they would usually assess risk for a 78-year-old community-dwelling patient without dementia but not for such a patient living in residential care or with dementia. DISCUSSION: This is New Zealand’s first report of GPs’ perspectives about assessing and managing CVD risk for older patients. Findings are consistent with international studies. More support and training in lifestyle assessment is needed, as well as clearer guidance for assessing and managing risk among older patients. KEYWORDS: Cardiovascular diseases; risk assessment; preventive medicine; geriatrics; public health