Abstract
Others have analysed the relationship between inadequate behaviour by healthcare professionals in the diagnosis of dyslipidaemia (diagnostic inertia) and the history of cardiovascular risk factors. However, since no study has assessed cardiovascular risk scores as associated factors, we carried out a study to quantify diagnostic inertia in dyslipidaemia and to determine if cardiovascular risk scores are associated with this inertia. In the Valencian Community (Spain), a preventive programme (cardiovascular, gynaecologic and vaccination) was started in 2003 inviting persons aged ≥40 years to undergo a health check-up at their health centre. This cross-sectional study examined persons with no known dyslipidaemia seen during the first six months of the programme (n = 16, 905) but whose total cholesterol (TC) was ≥5.17 mmol/L. Diagnostic inertia was defined as lack of follow-up to confirm/discard the dyslipidaemia diagnosis. Other variables included in the analysis were gender, history of cardiovascular risk factors/cardiovascular disease, counselling (diet/exercise), body mass index (BMI), age, blood pressure, fasting blood glucose and lipids. TC was grouped as ≥/<6.20 mmol/L. In patients without cardiovascular disease and <75/≤65 years (n = 15, 778/13, 597), the REGICOR (REgistre GIroní del COr)/SCORE (Systematic COronary Risk Evaluation) cardiovascular risk functions were used to classify risk (high/low). Inertia was quantified and the adjusted odds ratios calculated from multivariate models. In the overall sample, the rate of diagnostic inertia was 52% (95% CI [51.2–52.7]); associated factors were TC ≥ 6.20 mmol/L, high or “not measured” BMI, hypertension, smoking and higher values of fasting blood glucose, systolic blood pressure and TC. In the REGICOR sample, the rate of diagnostic inertia was 51.9% (95% CI [51.1–52.7]); associated factors were REGICOR high and high or “not measured” BMI. In the SCORE sample the rate of diagnostic inertia was 51.7% (95% CI [50.9–52.5]); associated factors were SCORE high and high or “not measured” BMI. Diagnostic inertia existed in over half the patients and was associated with a greater cardiovascular risk.
Highlights
Despite the great advances in medicine, coronary heart disease (CHD) and stroke have remained the main causes of death worldwide for over a decade (WHO, 2014)
Most of those who participated in the study were women (60.6%), there was a high prevalence of cardiovascular risk factors (CVRF), almost 4% of cardiovascular disease (CVD), and the vast majority of the patients had total cholesterol (TC) concentrations below 6.20 mmol/L (69.5%)
This study shows that a greater cardiovascular risk is related to experiencing diagnostic inertia when the physician fails in the interpretation of altered TC levels in patients who have no personal history of dyslipidaemia
Summary
Despite the great advances in medicine, coronary heart disease (CHD) and stroke have remained the main causes of death worldwide for over a decade (WHO, 2014). Mathematical models based on scoring systems have been used to determine the main risk factors for these diseases These factors can be classified as non-modifiable (male gender and older age) and modifiable (altered lipid levels, diabetes mellitus, high blood pressure and smoking). This meant that, if a patient had a TC concentration above this threshold, the patient should undergo a second measurement to confirm or discard the diagnosis of dyslipidaemia (NCEP & ATP III, 2002; Villar Alvarez et al, 2003) If, after this second measurement, the physician diagnoses dyslipidaemia, he or she should act according to the relevant guidelines. This action involves various possibilities, including dietary and hygiene measures or pharmacologic treatment (statins, fibrates and resins) (NCEP & ATP III, 2002; Villar Alvarez et al, 2003)
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