V Pallares-Carratalá1,2, I Bonig-Trigueros3, A Palazón-Bru4,5, A Lorenzo-Piqueres6, F Valls-Roca7, D Orozco-Beltrán4, V F Gil-Guillen4,5. 1. Health Surveillance Department, Mutual Society of Castellón, Castellón, Spain. 2. Department of Medicine, Jaume I University, Castellón, Spain. 3. Internal Medicine Service, La Plana Hospital, Vila-real, Spain. 4. Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain. 5. Research Unit, Elda General Hospital, Elda, Spain. 6. Teaching Unit of Primary Health Care, Generalitat Valenciana, Castellón, Spain. 7. Health Centre of Benigánim, Generalitat Valenciana, Benigánim, Spain.
Abstract
AIMS: The aim of this study was to quantify diagnostic inertia (DI) when the physician fails to diagnose hypertension and determine its associated factors. METHODS: This cross-sectional, observational study involved all patients without a diagnosis of hypertension who had their blood pressure (BP) measured at least three times during the second half of 2010 (N = 48,605). Patients with altered mean BP figures (≥ 140/90 mmHg) were considered to experience DI. Secondary variables: gender, atrial fibrillation, diabetes mellitus, dyslipidemia, cardiovascular disease, age and the physician having attended a cardiovascular training course (ESCARVAL). Associated factors were assessed by multivariate logistic regression analysis. RESULTS: Diagnostic inertia was present in 6450 patients (13.3%, 95% CI: 13.0-13.6%). Factors significantly associated with DI were: male gender (OR = 1.46, 95% CI: 1.37-1.55, p < 0.001), atrial fibrillation (OR = 0.73, 95% CI: 0.58-0.92, p = 0.007), the ESCARVAL cardiovascular course (OR = 0.88, 95% CI: 0.81-0.96, p = 0.005), diabetes mellitus (OR = 0.93, 95% CI: 0.87-0.99, p = 0.016), cardiovascular disease (OR = 0.77, 95% CI: 0.67-0.88, p < 0.001) and older age (years) (18-44→OR = 1; 45-59→OR = 12.45, 95% CI: 11.11-13.94; 60-74→OR = 18.11, 95% CI: 16.30-20.12; ≥ 75→OR = 20.43, 95% CI: 18.34-22.75; p < 0.001). The multivariate model had an area under the ROC curve of 0.81 (95% CI: 0.80-0.81, p < 0.001). CONCLUSIONS: This study will help clinical researchers differentiate between the two forms of DI (interpretation of a positive screening test and interpretation of positive diagnostic criteria). The results found here in patients with hypertension suggest that this problem is prevalent, and that a set of associated factors can explain the outcome well (AUC>0.80).
AIMS: The aim of this study was to quantify diagnostic inertia (DI) when the physician fails to diagnose hypertension and determine its associated factors. METHODS: This cross-sectional, observational study involved all patients without a diagnosis of hypertension who had their blood pressure (BP) measured at least three times during the second half of 2010 (N = 48,605). Patients with altered mean BP figures (≥ 140/90 mmHg) were considered to experience DI. Secondary variables: gender, atrial fibrillation, diabetes mellitus, dyslipidemia, cardiovascular disease, age and the physician having attended a cardiovascular training course (ESCARVAL). Associated factors were assessed by multivariate logistic regression analysis. RESULTS: Diagnostic inertia was present in 6450 patients (13.3%, 95% CI: 13.0-13.6%). Factors significantly associated with DI were: male gender (OR = 1.46, 95% CI: 1.37-1.55, p < 0.001), atrial fibrillation (OR = 0.73, 95% CI: 0.58-0.92, p = 0.007), the ESCARVAL cardiovascular course (OR = 0.88, 95% CI: 0.81-0.96, p = 0.005), diabetes mellitus (OR = 0.93, 95% CI: 0.87-0.99, p = 0.016), cardiovascular disease (OR = 0.77, 95% CI: 0.67-0.88, p < 0.001) and older age (years) (18-44→OR = 1; 45-59→OR = 12.45, 95% CI: 11.11-13.94; 60-74→OR = 18.11, 95% CI: 16.30-20.12; ≥ 75→OR = 20.43, 95% CI: 18.34-22.75; p < 0.001). The multivariate model had an area under the ROC curve of 0.81 (95% CI: 0.80-0.81, p < 0.001). CONCLUSIONS: This study will help clinical researchers differentiate between the two forms of DI (interpretation of a positive screening test and interpretation of positive diagnostic criteria). The results found here in patients with hypertension suggest that this problem is prevalent, and that a set of associated factors can explain the outcome well (AUC>0.80).
Authors: Vicente Pallares-Carratala; Concepcion Carratala-Munuera; Adriana Lopez-Pineda; Jose Antonio Quesada; Vicente Gil-Guillen; Domingo Orozco-Beltran; Jose L Alfonso-Sanchez; Jorge Navarro-Perez; Jose M Martin-Moreno Journal: Front Cardiovasc Med Date: 2022-06-16
Authors: Concepción Carratala-Munuera; Adriana Lopez-Pineda; Domingo Orozco-Beltran; Jose A Quesada; Jose L Alfonso-Sanchez; Vicente Pallarés-Carratalá; Cristina Soriano-Maldonado; Jorge Navarro-Perez; Vicente F Gil-Guillen; Jose M Martin-Moreno Journal: Int J Environ Res Public Health Date: 2021-04-12 Impact factor: 3.390
Authors: Cristina Soriano-Maldonado; Adriana Lopez-Pineda; Domingo Orozco-Beltran; Jose A Quesada; Jose L Alfonso-Sanchez; Vicente Pallarés-Carratalá; Jorge Navarro-Perez; Vicente F Gil-Guillen; Jose M Martin-Moreno; Concepción Carratala-Munuera Journal: Int J Environ Res Public Health Date: 2021-11-25 Impact factor: 3.390