Accuracy – ABC CARDIOL

IJCS

Original Article

Accuracy of Self-Reported Arterial Hypertension in Brazil: Systematic Review and Meta-Analysis

Jessica Pronestino de Lima Moreira et al. Renan Moritz Varnier Rodrigues de Almeida Ronir Raggio Luiz

Abstract

Background

Self-reported hypertension is a useful method to estimate prevalence in the population. However, it is necessary to evaluate its accuracy, in relation to the gold-standard diagnostic methods of the disease.

Objectives

To estimate combined measures of sensitivity and specificity for self-reported hypertension, using Brazilian validation studies that included gold standard methods.

Methods

A systematic review and a meta-analysis were developed. Two independent examiners evaluated 1389 and read 113 potentially eligible articles. Since self-reported morbidity is influenced by the cultural and economic characteristics of a population, as well as by its accessibility to medical care, only studies from one country (Brazil) were included. First, a qualitative analysis was performed, evaluating the relationship between self-reported hypertension and its measurement through gold-standard methods. Subsequently, a meta-analysis estimated the combined sensitivity and specificity for the included studies. Due to a high heterogeneity among studies, the meta-analysis used a random effects model. Bias risks were evaluated by the QUADAS-2 protocol and the standard significance level of 10% was used in all modelling.

Results

Five studies were included in the qualitative analysis; and four had the necessary information for inclusion in the meta-analysis. Patient selection and Index Test (the question allowing for self-reporting) were the domains with the highest risk of bias. In the meta-analysis, combined sensitivity and specificity were 77%(95%CI:[74.5-79.0%]) and 88%(95%CI:[86.3-88.6%]), respectively.

Conclusions

The analysed studies allowed for the estimation of more reliable values for combined sensitivity and specificity. These values were higher than those usually found in studies with greater population heterogeneity.

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ABC

Letter to the Editor

Association is Not the Same as Accuracy

Luis Cláudio Lemos Correia et al. Carolina Esteves Barbosa

Dear Editor,

In a recent article, dos Santos et al. have concluded that, for patients with acute coronary syndromes, risk scores correlated with coronary artery disease severity. That apparently positive conclusion hides the poor performance of those scores to predict obstructive coronary artery disease due to two reasons. Firstly, in face of a diagnostic situation (presence of coronary artery disease ≥ 50%), the clinical focus should be on accuracy. Secondly, association (described in the article as correlation) does not ensure accuracy.

The major focus of that study should have been accuracy measures, such as area under the ROC curve, ranging from 0.56 to 0.70. Although statistically significant, those values indicate low accuracy from the diagnostic viewpoint. Corroborating those findings, in a recently published article in this same journal, our group has concluded that the degree of association (between scores and coronary anatomy) is not sufficient for risk scores to accurately predict the results of angiography.

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