Analysing the concept of diagnostic inertia in hypertension: a cross‐sectional study. Issue 7 (10th May 2016)

• Record Type: Journal Article
• Authors: Pallares‐Carratalá, V.; Bonig‐Trigueros, I.; Palazón‐Bru, A.; Lorenzo‐Piqueres, A.; Valls‐Roca, F.; Orozco‐Beltrán, D.; Gil‐Guillen, V. F.
• Other Names: Sanchis‐Domenech Carlos investigator.; Martín‐Moreno José María investigator.; Redón Josep investigator.; Navarro‐Pérez Jorge investigator.; Fernández‐Giménez Antonio investigator.; Pérez‐Navarro Ana María investigator.
• Is Part Of: International journal of clinical practice. Volume 70:Issue 7(2016)
• Page Start: 619
• Page End: 624
• Publication Date: 2016-05-10
• Subjects: Clinical medicine -- Periodicals; Medicine -- Periodicals; 610.5
• DOI: 10.1111/ijcp.12825
• Languages: English
• ISSNs: 1368-5031

Abstract

Summary: 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).