Original scientific paper
Accuracy of General Practitioners’ Assessment of Chest Pain Patients for Coronary Heart Disease in Primary Care: Cross-sectional Study with Follow-up
Stefan Bösner
; Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany
Jörg Haasenritter
; Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany
Maren Abu Hani
; Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany
Heidi Keller
; Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany
Andreas C. Sönnichsen
; Department of Family Medicine Paracelsus University, Salzburg, Austria
Konstantinos Karatolios
; Department of Cardiology, University of Marburg, Marburg Germany
Juergen R. Schaefer
; Department of Cardiology, University of Marburg, Marburg Germany
Erika Baum
; Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany
Norbert Donner Banzhoff
; Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany
Abstract
Aim To estimate how accurately general practitioners’ (GP)
assessed the probability of coronary heart disease in patients
presenting with chest pain and analyze the patient
management decisions taken as a result.
Methods During 2005 and 2006, the cross-sectional diagnostic
study with a delayed-type reference standard included
74 GPs in the German state of Hesse, who enrolled
1249 consecutive patients presenting with chest pain. GPs
recorded symptoms and findings for each patient on a report
form. Patients and GPs were contacted 6 weeks and
6 months after the patients’ visit to the GP. Data on chest
complaints, investigations, hospitalization, and medication
were reviewed by an independent panel, with coronary
heart disease being the reference condition. Diagnostic
properties (sensitivity, specificity, and predictive values) of
the GPs’ diagnoses were calculated.
Results GPs diagnosed coronary heart disease with the
sensitivity of 69% (95% confidence interval [CI], 62-75) and
specificity of 89% (95% CI, 87-91), and acute coronary syndrome
with the sensitivity of 50% (95% CI, 36-64) and specificity
of 98% (95% CI, 97-99). They assumed coronary heart
disease in 245 patients, 41 (17%) of whom were referred to
the hospital, 77 (31%) to a cardiologist, and 162 (66%) to
electrocardiogram testing.
Conclusions GPs’ evaluation of chest pain patients, based
on symptoms and signs alone, was not sufficiently accurate
for diagnosing or excluding coronary heart disease or
acute coronary syndrome.
Keywords
sensitivity and specificity; chest pain; prevalence; primary health care; family practice; myocardial ischemia
Hrčak ID:
57678
URI
Publication date:
15.6.2010.
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