RESUMO
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) (18-44âOR = 1; 45-59âOR = 12.45, 95% CI: 11.11-13.94; 60-74âOR = 18.11, 95% CI: 16.30-20.12; ≥ 75âOR = 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).
Assuntos
Hipertensão/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Pressão Sanguínea , Estudos Transversais , Erros de Diagnóstico/estatística & dados numéricos , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto JovemRESUMO
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Assuntos
Humanos , Adulto , Feminino , Idoso , Masculino , Pessoa de Meia-Idade , Estilo de Vida , Atenção Primária à Saúde , Anti-Hipertensivos , Doenças Cardiovasculares , Estudos de Coortes , Fatores Etários , Hipercolesterolemia , Tabagismo , Prevenção Primária , Fatores Sexuais , Hipolipemiantes , Fatores de Risco , HipertensãoAssuntos
Doenças Cardiovasculares/prevenção & controle , Adulto , Fatores Etários , Idoso , Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Feminino , Humanos , Hipercolesterolemia/complicações , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Prevenção Primária , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Prevenção do Hábito de FumarRESUMO
Acute myocardiac infarction (AMI) in young patients is not a common occurrence; between 3% and 7% of all AMIS occur in persons under 40. A number of Risk Factors (RF) have been identified as associated with this disease, although in this age group, smoking at 70%, is the most frequent RF, followed by cholesterol, also high-risk at 44.3%, diabetes and AHT, although important RFS, are less frequent in this age group. Familiarization with these Risk Factors will form the basis of primary prevention of this disease directed both at the population at large and at those individuals already identified as most at risk.
