title: General Practitioners' Decision Making about Primary Prevention of Cardiovascular Disease in Older Adults: A Qualitative Study.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jesse
authors.initials: J
authors.lastname: Jansen
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Shannon
authors.identifier: http://orcid.org/0000-0001-6384-1745
authors.initials: S
authors.lastname: McKinn
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Carissa
authors.initials: C
authors.lastname: Bonner
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Les
authors.initials: L
authors.lastname: Irwig
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Doust
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Katy
authors.initials: K
authors.lastname: Bell
authors.affiliation: Centre for Education and Research on Ageing (CERA), Ageing and Alzheimer's Institute, Concord Hospital, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Vasi
authors.initials: V
authors.lastname: Naganathan
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000150:complications / Q000517:prevention & control*; D000066491:Clinical Decision-Making; D005260:Female; D016330:Frail Elderly; D058005:General Practitioners / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D008019:Life Style; D008297:Male; D009517:New South Wales; D010817:Physician-Patient Relations; D011322:Primary Prevention; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors