Accuracy of symptoms and signs for coronary heart disease assessed in primary care |
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Authors: | Stefan B?sner Annette Becker Maren Abu Hani Heidi Keller Andreas C S?nnichsen J?rg Haasenritter Konstantinos Karatolios Juergen R Schaefer Erika Baum Norbert Donner-Banzhoff |
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Institution: | Department of General Practice/Family Medicine, University of Marburg, Germany;Department of Family Medicine, Paracelsus University, Salzburg, Austria;Department of General Practice/Family Medicine, University of Marburg, Germany;Department of Cardiology, University of Marburg, Germany;Department of General Practice/Family Medicine, University of Marburg, Germany |
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Abstract: | BackgroundDiagnosing the aetiology of chest pain is challenging. There is still a lack of data on the diagnostic accuracy of signs and symptoms for acute coronary events in low-prevalence settings.AimTo evaluate the diagnostic accuracy of symptoms and signs in patients presenting to general practice with chest pain.Design of studyCross-sectional diagnostic study with delayed-type reference standard.SettingSeventy-four general practices in Germany.MethodThe study included 1249 consecutive patients presenting with chest pain. Data were reviewed by an independent reference panel, with coronary heart disease (CHD) and an indication for urgent hospital admission as reference conditions. Main outcome measures were sensitivity, specificity, likelihood ratio, predictive value, and odds ratio (OR) for non-trauma patients with a reference diagnosis.ResultsSeveral signs and symptoms showed strong associations with CHD, including known vascular disease (OR = 5.13; 95% confidence interval CI] = 2.83 to 9.30), pain worse on exercise (OR = 4.27; 95% CI = 2.31 to 7.88), patient assumes cardiac origin of pain (OR = 3.20; 95% CI = 1.53 to 6.60), cough present (OR = 0.08; 95% CI = 0.01 to 0.77), and pain reproducible on palpation (OR = 0.27; 95% CI = 0.13 to 0.56). For urgent hospital admission, effective criteria included pain radiating to the left arm (OR = 8.81; 95% CI = 2.58 to 30.05), known clinical vascular disease (OR = 7.50; 95% CI = 2.88 to 19.55), home visit requested (OR = 7.31; 95% CI = 2.27 to 23.57), and known heart failure (OR = 3.53; 95% CI = 1.14 to 10.96).ConclusionAlthough individual criteria were only moderately effective, in combination they can help to decide about further management of patients with chest pain in primary care. |
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Keywords: | chest pain medical history taking myocardial ischaemia primary health care sensitivity and specificity |
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