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Exercise testing and myocardial perfusion scintigraphy in primary care patients with chest pain of new onset
Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology. (Landstinget i Östergötland)
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
2007 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 2, 117-122 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To analyse the outcome of exercise testing and myocardial perfusion scintigraphy (MPS) in primary care patients with chest pain of new onset.

Design: Prospective, observational. Patients aged 20-79 years, consulting due to chest pain of new onset, were enrolled consecutively.

Setting: Three primary care health centres in south-eastern Sweden.

Patients: 191 patients where the possibility of stable ischaemic heart disease (IHD) could not be excluded by clinical examination alone.

Main outcome measures: Exercise test results, when equivocal completed by MPS.

Results: Exercise testing revealed IHD in 14 (7%) and no IHD in 134 (70%) of the cases. In 43 (23%) the exercise test results were equivocal. Thirty-nine of these patients underwent MPS, which showed IHD in 19 and no IHD in 20 cases. Among previously diagnosed cardiovascular disease and risk factors only atrial fibrillation in the male group showed a significant correlation to the outcome IHD.

Conclusion: Exercise testing and MPS are both useful when investigating chest pain patients in primary care.

Place, publisher, year, edition, pages
2007. Vol. 25, no 2, 117-122 p.
Keyword [en]
Chest pain, exercise test, family practice, myocardial ischaemia, myocardial perfusion imaging, primary healthcare, risk factors
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13083DOI: 10.1080/02813430601116249OAI: oai:DiVA.org:liu-13083DiVA: diva2:17794
Available from: 2008-03-25 Created: 2008-03-25 Last updated: 2017-12-13
In thesis
1. Chest pain and ischemic heart disease: Diagnosis and management in primary health care
Open this publication in new window or tab >>Chest pain and ischemic heart disease: Diagnosis and management in primary health care
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims. In patients consulting for chest pain, it is of great importance to evaluate the possibility of ischemic heart disease (IHD). The aims in this thesis were to investigate the accuracy of the general practitioners’ clinical assessments and the applicability of exercise testing and myocardial perfusion scintigraphy (MPS) in patients consulting for chest pain in primary care.

Statins are known to prevent IHD. A further aim was therefore to investigate if a relation could be detected on a population basis between the use of statins and the morbidity of acute myocardial infarction (AMI).

Methods. All patients from 20 to 79 years, consulting for a new episode of chest pain in three primary health care centres, were included during almost two years from 1998 to 2000. The patients were managed according to the clinical evaluation. The presence of IHD was excluded either by clinical examination only, or if stable IHD was in question, by exercise testing and if the exercise test was inconclusive by an additional MPS. If unstable IHD or myocardial infarction was suspected, referral for emergency hospital examination was made.

Correlations between statin sales and the morbidity of AMI in Sweden’s municipalities were analysed in an ecological, register based study. Adjustment was made for sales of antidiabetics, socio-economic deprivation indexes and geographic coordinates.

Results. Consultations for chest pain represented 1.5% of all consultations in the ages 20 to 79 and were made by 554 patients. In 281 patients IHD was excluded by clinical examination only. In 208 patients stable IHD and in 65 unstable IHD was in question. Four patients (1.4%) evaluated as not having IHD, were diagnosed with angina pectoris or AMI within three months. Exercise testing was performed in 191 patients and revealed no IHD in 134 and IHD in 14 patients. In 43 patients the exercise test results were equivocal. Thirty-nine of these patients underwent MPS, which showed no IHD in 20 and IHD in 19 of the patients.

In a follow up almost six years later, neither mortality rate nor prevalence of IHD differed significantly between the 384 study patients evaluated not to have IHD and the population controls.

Statin sales and AMI-incidence or mortality showed no strong associations from 1998 to 2002.

Conclusions.

·Primary care is an appropriate level of care for ruling out IHD as the cause of chest pain, with sufficient safety and for diagnostics of stable IHD.

·Exercise testing and myocardial perfusion scintigraphy are useful procedures when investigating chest pain patients in primary care.

·The results indicate that preventive measures other than increased statin treatment should be considered to further decrease AMI-morbidity.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2008. 253 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1039
Keyword
Chest pain, ischemic heart disease, primary health care, diagnosis, lipid lowering drugs
National Category
Clinical Science
Identifiers
urn:nbn:se:liu:diva-11390 (URN)978-91-7393-987-4 (ISBN)
Public defence
2008-04-11, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-03-25 Created: 2008-03-25 Last updated: 2009-08-21

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Nilsson, StaffanNylander, Eva

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