Younger Doctors More Likely to Prescribe Drugs for Heart Disease Risks
Your doctor’s age may, in part, determine the approach taken in treating you. Italian researchers have found patients at risk of heart disease were more likely to be prescribed medication if seen by a younger doctor whereas they were more likely to receive lifestyle change recommendations when seen by an older doctor.
Professor Massimo Volpe, cardiologist from the Faculty of Medicine at Sapienza University, Rome, and colleagues have published their findings in the June issue of the International Journal of Clinical Practice.
Older individuals have higher and longer interactions with major CV risk factors which include smoking, hypertension, obesity, dyslipidemia and diabetes mellitus.
"While physicians recognize the importance of patients' age as a major driver for CV risk, little evidence is available on the potential impact of the doctor's age on how they manage clinical risk" says Volpe.
The Evaluation of Final Feasible Effect of Ultra Control Training and Sensitisation (EFFECTUS) program is a multicentre, observational study, designed to raise awareness on global CV risk management and control among physicians operating in the daily clinical practice in Italy.
In the present analysis, the researchers examined the potential influence of physicians’ age on strategies for the clinical management of global CV risk by evaluating the potential differences and discrepancies among physicians involved in the EFFECTUS program. Physicians’ recruitment was accomplished in May 2006, randomly selecting a sample of the physicians in Italy, from a community of medical doctors.
Overall, the survey generated a population sample of 1078 physicians (89.8% of the planned sample size) and reflected approximately an outpatient practice of about 11,000 patients per week. The participating physicians were stratified according to their age into three groups (≤ 45 years, 46–55 years and > 55 years). All were blind to the final purpose of the study.
All the doctors were asked to fill in questionnaires on themselves and their practice and reply anonymously on the administrative site of their regional referral centre. They were also asked to provide clinical details of the first 10 white patients over 50 they saw, for any reason, after they agreed to take part.
A fifth of the doctors (20%) were under 45 years of age, 61% were 46-55 and 19% were over 55. Female doctors accounted for 27% of the total sample and tended to be younger, ranging from 47% of those under 45 to just 8% of those over 55.
Family doctors accounted for 78% of the total sample, followed by cardiologists (13%) and diabetologists (9%). The youngest age group included the fewest GPs (53%) and most cardiologists (31%), with the highest percentage of GPs in the 46-55 age group (86%).
Just over half of the patients (54%) were male. The average age was 67 and the ages of the patients treated by the doctors in the various age groups was very similar. However, doctors over 55 tended to treat more male patients, obese patients and smokers.
The researchers found the older physicians frequently recommended life-style changes, whereas a higher number of antihypertensive, antiplatelet, glucose and lipid-lowering prescriptions was prescribed by physicians aged ≤ 45 years.
Volpe noted, "Although younger doctors prescribed more drugs, this did not result in significantly better control of their patients' major CV risk factors, suggesting that other factors have an important role to play in the clinical management of CV risk, including lifestyle changes."
The researchers noted high blood pressure was the most common CV risk factor, affecting 75% of patients, followed by abnormal lipid (cholesterol and/or fat in the blood) in 59% of patients and diabetes mellitus in 37%. In each case, the percentage was highest in patients managed by doctors under 45.
Blood pressure drugs were the most commonly prescribed, by 83% of doctors under 45, 78% of doctors aged 46-55 year-old and 80% of doctors over 55. However, not all patients with high blood pressure were prescribed drugs, regardless of the age of their physician.
Younger doctors were also more likely to prescribe antidiabetic drugs, lipid lowering agents and antiplatelet agents than their older colleagues.
Older doctors were more likely to recommend lifestyle changes. Smoking cessation advice was highest in doctors over 55 and diet and exercise advice highest in doctors aged 46-55.
Older doctors also tended to be more thorough and accurate when it came to recording clinical data on their patients. Previous analysis of the data provided showed a close relationship between high levels of accuracy and better CV outcomes.
"Our study demonstrated a significantly higher prevalence of major CV risk factors and associated clinical conditions among patients treated by younger, specialized doctors, rather than older doctors, who were more likely to be GPs" says Professor Volpe.
"Younger doctors were also more likely to prescribe medication and less likely to recommend lifestyle changes than their older colleagues. However this increased prescribing was not reflected in significantly better clinical management of CV risk factors.
"We believe these findings have important implications for the ongoing professional education of doctors treating patients with CV risk."
Impact of physicians' age on the clinical management of global cardiovascular risk: analysis of the results of the Evaluation of Final Feasible Effect of Control Training and Ultra Sensitisation Educational Programme; Tocci et al; IJCP. 65, pp649-657. (June 2011). DOI: 10.1111/j.1742-1241.2011.02664.x
Wiley Publishing press release