A Nationwide Flash-Mob Study for Suspected Acute Coronary Syndrome

Abstract

PURPOSE Our primary objective was to evaluate the Marburg Heart Score (MHS), a clinical decision rule, or to develop an adapted clinical decision rule for family physicians (FPs) to safely rule out acute coronary syndrome (ACS) in patients referred to secondary care for suspected ACS. The secondary objective was to evaluate the feasibility of using the flash-mob method, an innovative study design, for large-scale research in family medicine. METHODSIn this 2-week, nationwide, prospective, observational, flash-mob study, FPs collected data on possible ACS predictors and assessed ACS probability (on a scale of 1-10) in patients referred to secondary care for suspected ACS. RESULTSWe collected data for 258 patients in 2 weeks by mobilizing approximately 1 in 5 FPs throughout the country via ambassadors. A final diagnosis was obtained for 243 patients (94.2%), of whom 45 (18.5%) received a diagnosis of ACS. Sex, sex-adjusted age, and ischemic changes on electrocardiography were significantly associated with ACS. The sensitivity of the MHS (cut-off ≤2) was 75.0%, specificity was 44.0%, positive predictive value was 24.3%, and negative predictive value was 88.0%. For the FP assessment (cut-off ≤5), these test characteristics were 86.7%, 41.4%, 25.2%, and 93.2%, respectively.CONCLUSIONS For patients referred to emergency care, ACS could not be safely ruled out using the MHS or FP clinical assessment. The flash-mob study design may be a feasible alternative research method to investigate relatively simple, clinically relevant research questions in family medicine on a large scale and over a relatively short time frame.

Performance of a simplified HEART score and HEART-GP score for evaluating chest pain in urgent primary care

“…These studies showed mediocre discriminatory properties (C-statistic 0.66–0.72), and unaided clinical judgement provided a better overall fit (C-statistic of 0.75), with poor agreement in risk estimation (in half of cases) [ 6 , 17 , 18 ]. Recently, a 2-week flash-mob study was performed among Dutch GPs in which the Marburg Heart Score was evaluated for its properties for ruling out ACS in patients referred for suspected ACS [ 19 ]. Overall, the diagnostic properties in terms of predictive values of the Marburg Heart Score, as for the other risk assessment tools, were not superior to unaided GP assessment.…”

Recent developments in diagnosis and risk stratification of non-ST-elevation acute coronary syndrome

“…Schols et al. conducted a nationwide flash-mob study in the Netherlands to evaluate the safety of the Marburg Heart Score (MHS) to rule out ACS [ 20 ]. The MHS is a clinical decision rule based on five signs and symptoms, which was designed to identify patients with a low probability of ACS as the underlying cause of chest pain in the primary care population [ 21 , 22 ].…”

De huisarts is een prima sneltest bij pijn op de borst

“…Een sneltest die 45 euro zou kosten, zou tot 40% reductie van deze fout-positieven moeten leiden om kostenneutraal te zijn. 23 Iedere 1% verdere daling van de achteraf onterechte verwijzingen zou een kostenbesparing van 1 miljoen euro opleveren. In een prospectief onderzoek vonden we dat een beslisregel bestaande uit enkele van de best voorspellende symptomen én een H-FABP-sneltest een iets hogere negatief voorspellende waarde had dan de huisarts zónder aanvullende beslisregel of biomarkertest (97,2% versus 95,8%).…”