Accuracy of symptoms and signs for coronary heart disease assessed in primary care

Abstract

Diagnosing 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.Keywords chest pain; medical history taking; myocardial ischaemia; primary health care; sensitivity and specificity.

Accuracy of General Practitioners’ Assessment of Chest Pain Patients for Coronary Heart Disease in Primary Care: Cross-sectional Study with Follow-up

“…The data for this study came from a larger project aimed at investigating the accuracy of signs and symptoms for chest pain patients with CHD, and the methodology and results of the main study have been presented elsewhere (5,11). In the present study, a secondary analysis was conducted to assess the accuracy of GPs' diagnostic assessment of chest pain patients in primary care facilities in the state of Hesse, Germany.…”

Reliable classification: Learning classifiers that distinguish aleatoric and epistemic uncertainty

“…All the more it is important to incorporate measures of reliability into computer systems assisting the GP. Design and conduct of the study were described elsewhere [5].…”

“…The first one is standard logistic regression (LR), which is a quite common approach in medical data analysis in general and was also used for analyzing our data set in [5]. Since this classifier fits a linear decision boundary in the instance space, it is rather restrictive and makes strong model assumptions.…”

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

“…Это правило сле-дует использовать в контексте другой клинической информации, как например, наличия кашля или острой жгучей боли (что делает диагноз ИБС менее вероятным). И наоборот, такие признаки, как ирра-диация боли в левую руку, известная сердечная недо-статочность и сахарный диабет делают диагноз ИБС более вероятным [55].…”