General Practitioners' Decision Making about Primary Prevention of Cardiovascular Disease in Older Adults: A Qualitative Study

PLoS One. 2017 Jan 13;12(1):e0170228. doi: 10.1371/journal.pone.0170228. eCollection 2017.

Abstract

Background: Primary cardiovascular disease (CVD) prevention in older people is challenging as they are a diverse group with varying needs, frequent presence of comorbidities, and are more susceptible to treatment harms. Moreover the potential benefits and harms of preventive medication for older people are uncertain. We explored GPs' decision making about primary CVD prevention in patients aged 75 years and older.

Method: 25 GPs participated in semi-structured interviews in New South Wales, Australia. Transcribed audio-recordings were thematically coded and Framework Analysis was used.

Results: Analysis identified factors that are likely to contribute to variation in the management of CVD risk in older people. Some GPs based CVD prevention on guidelines regardless of patient age. Others tailored management based on factors such as perceptions of prevention in older age, knowledge of limited evidence, comorbidities, polypharmacy, frailty, and life expectancy. GPs were more confident about: 1) medication and lifestyle change for fit/healthy older patients, and 2) stopping or avoiding medication for frail/nursing home patients. Decision making for older patients outside of these categories was less clear.

Conclusion: Older patients receive different care depending on their GP's perceptions of ageing and CVD prevention, and their knowledge of available evidence. GPs consider CVD prevention for older patients challenging and would welcome more guidance in this area.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Attitude of Health Personnel
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / prevention & control*
  • Clinical Decision-Making*
  • Female
  • Frail Elderly
  • General Practitioners / psychology*
  • Health Status
  • Humans
  • Life Expectancy
  • Life Style
  • Male
  • New South Wales
  • Physician-Patient Relations
  • Primary Prevention*
  • Quality of Life
  • Risk Assessment / methods
  • Risk Factors

Grant support

The study was funded by the National Health and Medical Research Council (NHMRC), through grants awarded to the Screening and Test Evaluation Program (no. 633003) and Bond University (no. 511217). CB was supported by an Australian Postgraduate Award. JJ and KM were supported by NHMRC fellowships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.