Objective Observational study of patients with chest pain in primary care: determination of incidence, referral rate, diagnostic tests and (agreement between) working and final diagnoses.
Methods 118 general practitioners (GPs) in the Netherlands and Belgium recorded all patient contacts during 2weeks. Furthermore, patients presenting with chest pain were registered extensively. A follow-up form was filled in after 30 days.
Results 22 294 patient contacts were registered. In 281 (1.26%), chest pain was a reason for consulting the GP (mean age for men 54.4/women 53 years). In this cohort of 281 patients, in 38.1% of patients, acute coronary syndrome (ACS) was suspected at least temporarily during consultation, 40.2% of patients were referred to secondary care and 512 diagnostic tests were performed by GPs and consulted specialists. Musculoskeletal pain was the most frequent working (26.1%) and final diagnoses (33.1%). Potentially life-threatening diseases as final diagnosis (such as myocardial infarction) accounted for 8.4% of all chest pain cases. In 23.1% of cases, a major difference between working and final diagnoses was found, in 0.7% a severe disease was initially missed by the GP.
Conclusion Chest pain was present in 281 patients (1.26% of all consultations). Final diagnoses were mostly non-life-threatening. Nevertheless, in 8.4% of patients with chest pain, life-threatening underlying causes were identified. This seems reflected in the magnitude and wide variety of diagnostic tests performed in these patients by GPs and specialists, in the (safe) overestimation of life-threatening diseases by GPs at initial assessment and in the high referral rate we found.
- health care delivery
- quality and outcomes of care
- coronary artery disease
- acute coronary syndromes
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Funding The study is funded by means of an unrestricted grant by FABPulous BV, the company that develops point-of care H-FABP-tests. FABPulous BV agreed not to interfere with data collection, data management and analysis of data. Publication of possible unfavorable outcome of our study was guaranteed.
Competing interests JFCG is chief scientific officer (CSO) at FABPulous BV. The remaining authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Patient consent Not applicable.
Provenance and peer review Not commissioned; externally peer reviewed.
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