title: Diagnostic inertia in obesity and the impact on cardiovascular risk in primary care: a cross-sectional study.
abstract: BACKGROUND
  Prevalence of diagnostic inertia (DI), defined as a failure to diagnose disease, has not been analysed in patients with obesity.
  
  
  OBJECTIVE
  To quantify DI for cardiovascular risk factors (CVRF) in patients with obesity, and determine its association with the cardiovascular risk score.
  
  
  METHODS
  Cross-sectional study of people ≥40 years attending a preventive programme in primary healthcare centres in Spain in 2003-2004.
  
  
  METHODS
  All 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.
  
  
  RESULTS
  Of 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.
  
  
  CONCLUSIONS
  This study quantified DI in patients with obesity and determined that it was associated with a greater cardiovascular risk.
authors.affiliation: Department of Clinical Medicine;
authors.forename: Damian R J
authors.initials: DR
authors.lastname: Martínez-St John
authors.affiliation: Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, and Research Unit, Elda Hospital, Elda, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Palazón-Bru
authors.affiliation: Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, and Research Unit, Elda Hospital, Elda, Spain.
authors.forename: Vicente F
authors.initials: VF
authors.lastname: Gil-Guillén
authors.affiliation: Department of Clinical Medicine;
authors.forename: Armina
authors.initials: A
authors.lastname: Sepehri
authors.affiliation: Department of Clinical Medicine;
authors.forename: Felipe
authors.initials: F
authors.lastname: Navarro-Cremades
authors.affiliation: Research Unit, Elda Hospital, Elda, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Ramírez-Prado
authors.affiliation: Department of Clinical Medicine;
authors.forename: Domingo
authors.initials: D
authors.lastname: Orozco-Beltrán
authors.affiliation: Department of Clinical Medicine;
authors.forename: Concepción
authors.initials: C
authors.lastname: Carratalá-Munuera
authors.affiliation: Department of Pharmacology, Pediatrics, and Organic Chemistry, Miguel Hernández University, San Juan de Alicante, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Cortés
authors.affiliation: Department of Nursing, University of Alicante, San Vicente del Raspeig, Spain.
authors.forename: María M
authors.initials: MM
authors.lastname: Rizo-Baeza
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology
keywords: diabetes mellitus; dyslipidaemias; hypertension; inertia; obesity; physician’s practice patterns; primary health care