Missed opportunities to prevent hypertension at a tertiary care centre in Pakistan

Background: Cardiovascular disease is the leading cause of mortality worldwide, affecting similar to 1.28 billion adults, and similar to 46% of these adults are not aware of their condition. One-third of patients do not receive appropriate care for their cardiovascular disease. Aim: To identify missed opportunities to prevent cardiovascular disease and its associated risk factors. Methods: This study was conducted among 359 adult patients aged 18-77 years leaving the outpatient department of Civil Hospital, Karachi, Pakistan, during June to September 2020. We recorded their sociodemographic information, perceived duration of clinical consultation, body weight and height, and blood pressure. We investigated if their physicians obtained sufficient medical history, performed medical examination, or counselled them on cardiovascular disease risk factors. Data were analysed using SPSS version 24.0. Results: Almost all the participants (98%) had at least 1 risk factor for hypertension. Only 35.9% of those in the highrisk group with >= 3 risk factors received counselling from a physician about their hypertension, leaving a 37.6% missed opportunity rate. Conclusion: The frequency of missed opportunities for the prevention of cardiovascular disease, and the risk factors for hypertension were high among the study population. This was partly due to excess workload of the attending physicians; the outpatient departments were used more for the treatment of general ailments than for specialist and referral care. It is recommended to establish primary care clinics within the tertiary settings where cardiovascular risk factors can be evaluated and patients referred for appropriate care.