Diagnostic inertia in obesity and the impact on cardiovascular risk in primary care: a cross-sectional study

Abstract

BackgroundPrevalence of diagnostic inertia (DI), defined as a failure to diagnose disease, has not been analysed in patients with obesity. AimTo quantify DI for cardiovascular risk factors (CVRF) in patients with obesity, and determine its association with the cardiovascular risk score. Design and settingCross-sectional study of people ≥40 years attending a preventive programme in primary healthcare centres in Spain in [2003][2004]. MethodAll patients with obesity attending during the first 6 months of the preventive programme were analysed. Participants had to be free of CVD (myocardial ischaemia or stroke) and aged 40-65 years; the criteria used to measure SCORE (Systematic COronary Risk Evaluation). Three subgroups of patients with obesity with no personal history of CVRF but with poor control of risk factors were established. Outcome variable was DI, defined as poor control of risk factors and no action taken by the physician. Secondary variables were diabetes, fasting blood glucose (FBG), body mass index (BMI), and SCORE. Adjusted odds ratios (OR) was determined using multivariate logistic regression models. ResultsOf 8687 patients with obesity in the programme, 6230 fulfilled SCORE criteria. Prevalence of DI in the three subgroups was: hypertension, 1275/1816 (70.2%) patients affected (95% CI = 68.1 to 72.3%); diabetes, 335/359 (93.3%) patients affected (95% CI = 90.7 to 95.9%); dyslipidaemia subgroup, 1796/3341 (53.8%) patients affected (95% CI = 52.1 to 55.4%. Factors associated with DI for each subgroup were: for hypertension, absence of diabetes, higher BMI, and greater cardiovascular risk; for dyslipidaemia, diabetes, higher BMI, and greater cardiovascular risk (SCORE); and for diabetes, lower FBG levels, lower BMI, and greater cardiovascular risk. ConclusionThis study quantified DI in patients with obesity and determined that it was associated with a greater cardiovascular risk.

Analysing the concept of diagnostic inertia in hypertension: a cross-sectional study

“…The first was conducted in the general population and the second was restricted to the obese population . These studies found a proportion of DI of 32.5% and 70.2%, respectively . Our magnitude is far below the values obtained by these authors, although we must bear in mind that we were working with three or more BP readings and these authors only analysed the interpretation of one altered screening test.…”

“…Lines of research are opening up that will help us determine the causes of this inertia. All previous publications have suggested that qualitative studies can help to reduce this proportion and provide a good basis for designing training programmes for primary care physicians to update their knowledge in cardiovascular disease . We believe this would be a good line of investigation by which we could reduce DI, achieving improved control of hypertension in our community, and therefore a possible decrease in the incidence of cardiovascular diseases.…”

“…This issue has been assessed in a preventive programme by two working groups. The first was conducted in the general population and the second was restricted to the obese population . These studies found a proportion of DI of 32.5% and 70.2%, respectively .…”

“…Resulting from this derivation of the classical concept by Phillips , several studies have analysed the attitude of physicians when interpreting altered results of a screening test for cardiovascular risk factors (hypertension, diabetes mellitus and dyslipidemia) . In 2014, Palazón‐Bru et al.…”

Levels of detection of hypertension in primary medical care and interventions to improve detection: a systematic review of the evidence since 2000

“…5 Since a third or more of adults with hypertension are not recorded on general practice registers, this suggests that the problem in detecting hypertension may not be primarily due to failure to check and record patients’ blood pressures, but that raised blood pressure readings are not adequately followed up until a diagnosis is confirmed, an example of diagnostic inertia (defined as a failure to diagnose disease). 13 The English national guidelines on hypertension in adults recommend that in people whose blood pressure is 140/90 or above in the clinic (two or more readings advised), ambulatory blood pressure monitoring or home blood pressure monitoring should be offered. 14 However, evidence about the factors explaining why these recommendations have not led to higher detection rates is limited.…”