liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The accuracy of general practitioners' clinical assessment of chest pain patients
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
(Primary Healthcare Centre, Åby, Sweden)
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
2008 (English)In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 14, no 2, 50-55 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To study general practitioners' (GP) assessment of the probability of ischaemic heart disease (IHD) and GP action in daily practice regarding chest pain patients.

Methods: All chest pain patients aged 20-79 years, attending three primary health-care centres in south-east Sweden and assessed by the GP to have high, low or very low probability of IHD, were included consecutively over a two year period. The “GP action in daily practice” was classed as “active decisions” (investigation or treatment) or “wait and see”. “IHD” or “not IHD” was settled according to the results of acute hospital investigation or exercise testing/myocardial perfusion scintigraphy.

Results: 516 patients were included, 93 high, 145 low and 278 very low probability cases. The outcome was “IHD” in 47%, 9% and 1% respectively. The sensitivity and specificity of the “GP assessment of the probability of IHD” were 72% and 89%. The sensitivity and specificity of the “GP action in daily practice” were 88% and 72%, respectively. The negative predictive value was 98%.

Conclusion: GP assessment, after clinical evaluation, that the probability of IHD was low did not safely rule out IHD. GP action in daily practice however, indicates that general practice is an appropriate level of care for chest pain patients.

Place, publisher, year, edition, pages
2008. Vol. 14, no 2, 50-55 p.
Keyword [en]
Chest Pain, Primary Health-care, Myocardial Ischaemia, Decision Making
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13084DOI: 10.1080/13814780802342622OAI: oai:DiVA.org:liu-13084DiVA: diva2:17795
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

Open Access in DiVA

No full text

Other links

Publisher's full textLink to Ph.D. thesis

Authority records BETA

Nilsson, StaffanMölstad, Sigvard

Search in DiVA

By author/editor
Nilsson, StaffanMölstad, Sigvard
By organisation
General PracticeFaculty of Health SciencesEast County Primary Health Care
In the same journal
European Journal of General Practice
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 107 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf