Study: Younger & older docs differ on CV disease treatments
Patients followed by younger physicians (age 45 and under) had a higher prevalence of cardiovascular (CV) disease, according to the results of the EFFECTUS study published in the International Journal of Clinical Practice. And while these patients may be sicker, younger physicians may be more apt to administer prescription drugs compared to older physicians who may prefer focusing on lifestyle changes.

“While physicians recognize the importance of patients’ age as a major driver for cardiovascular risk, yet few evidence are available regarding the potential impact of physicians’ age on clinical attitudes and preferences for the clinical management of patients at cardiovascular risk,” Giuliano Tocci, MD, of the University of Rome, Sant’Andrea Hospital in Rome, and colleagues wrote.

The researchers conducted the EFFECTUS (Evaluation of Final Feasible Effect of Ultra Control Training and Sensitisation) study to better understand the impact physicians’ ages had on CV risk. The study population included 1,078 physicians stratified to three age groups: 45 years or less (219 physicians), 46-55 (658 physicians) and 55 years and older (201 physicians). The physicians provided information on the first 10 outpatients they treated in May 2006.

Overall, the study collected data on 9,904 outpatients, of which 46.5 percent were female with an average age of 67 years.

The researchers reported that patients who were followed by older physicians (1,783 followed by those 55 and older) were more likely to be obese and smokers compared to those followed by physicians less than 55 years old.

While the researchers found no significant differences between major CV risk factors among the three groups, hypertension was more prevalent in patients who were followed by younger physicians compared to those followed by physicians age 46 or older. However, patients followed by younger physicians were more likely to experience an MI or stroke.

Patients followed by older physicians also had higher systolic and diastolic blood pressures, but patients followed by younger physicians had higher fasting glucose and HbA1c levels. Younger physicians, under the age of 45, also were more likely to prescribe CV drugs, including ACE inhibitors and beta-blockers.

And while younger physicians administered a greater number of ACE inhibitors and beta-blockers most likely due to the higher prevalence of hypertension and previous MIs and stroke, older physicians over age 46 were more likely to focus on pushing patients to adhere to lifestyle changes including smoking cessation, diet and physical activity. Additionally, older patients were also more likely to record major CV factors including blood pressure, glucose, cholesterol and triglyceride levels compared with younger physicians.

“The differences observed in CV drug prescriptions among the three groups, mostly ACE inhibitors, beta-blockers, glucose and lipid-lowering agents (i.e. statins), may be related to the higher prevalence of associated clinical conditions (history of MI, stroke and TIA) among patients followed by younger specialized physicians rather than in those followed by older physicians, who were more frequently general practitioners, as above mentioned,” the researchers  noted.

However, the researchers noted that even though CV drug use was greater in younger physicians, it did not result in better control of CV risk factors including high blood pressure and glucose levels. The authors wrote that this suggests “that other aspects should be taken into account in the clinical management of CV disease, beyond the number of prescriptions and dosages of drug molecules.”

The researchers found that arterial hypertension was the most frequent CV risk among Italian physicians, but the condition was under-diagnosed and treated. Tocci and colleagues urged that better management strategies for detecting and treating blood pressure levels are necessary.

The authors also found no significant difference in the use of advanced diagnostic examinations (echo, exercise stress testing and Doppler ultrasonography) between the three physician age groups; however younger physicians did prescribe a greater number of grade I diagnostic exams. "This trend may be of relevance for future guidelines for the clinical management of CV diseases, mostly hypertension, diabetes mellitus and CV disease prevention, since the latest sets of these guidelines strongly recommended the use of simple, largely available and less expensive tools for global CV risk stratification in individuals at CV risk," the authors wrote.
The researchers said that it should be noted that a potential limitation of the study comes from the fact that it only identified associations, but not causation.

“Specific training and educational programs for specialized physicians should be carefully considered, to improve quality of care, reduce doctor’s inertia and ameliorate the clinical management of CV diseases in Italy,” the researchers concluded.