Diagnosis and management of acute coronary syndrome in an outpatient setting: good guideline adherence in Swiss primary care

Acute coronary syndromes are considered as a global major health-care problem, and Iran as a developing country is of no exception. We aimed to investigate the degree of adherence to American College of Cardiology and American Heart Association (ACC/AHA) guideline for the management of non-ST-segment elevation myocardial infarction (NSTEMI) in patients who presented to the emergency department at Tehran Heart Center. Data of the patients who presented with acute chest pain to the emergency department of Tehran Heart Center within 1 year and were diagnosed as NSTEMI by the cardiologist in charge were included. The details of the initial managements based on the ACC/AHA guideline for NSTEMI of the patients were recorded from the patients' files in the emergency department for this study. Then, the frequency of guideline-related management in the study population was calculated and reported. A total of 684 patients [mean age = 62.95 ± 12.19 years; male gender = 460 (67.3%)] were diagnosed as NSTEMI at the emergency department of our center. Initial management based on the current guideline including administration of aspirin and clopidogrel was performed in 98.4% and 95.0%, respectively. Intravenous heparin was administered in 67.0% of the patients, whereas 30.8% of patients received enoxaparin. Following the initial management, coronary angiography was performed in 563 (82.3%) patients within 48 hours from the admission. Adherence to ACC/AHA guideline for the management of NSTEMI in patients who presented to a tertiary health-care center was in a high degree.

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Assessment of Adherence to ACC/AHA Guidelines in Primary Management of Patients With NSTEMI in a Referral Cardiology Hospital

Farahzadi

Shafiee²,

Bozorgi³

et al. 2015

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area

Harskamp,

Melessen,

Manten

et al. 2024

Diagnosis

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Objectives Troponin testing is indicated in the diagnostic work-up of acute coronary syndrome (ACS) and incorporated in risk stratification pathways. This study aims to gain insights on the use, outcomes, and diagnostic accuracy of troponin testing in routine primary care; a setting that is understudied. Methods Routine data were used from the academic primary care network in the Amsterdam metropolitan area (968,433 patient records). The study population included adult patients who underwent high-sensitivity troponin I or T (hs-TnI/T) testing between 2011 and 2021. The primary outcome was the reported diagnosis and the secondary outcome was the diagnostic accuracy measured by death or ACS at 30 days. Results 3,184 patients underwent hs-troponin testing, either with hsTNT (n=2,333) or hsTNI (n=851). Median patients’ age was 55 (44–65) years, and 62.3 % were female. Predominant symptoms were chest pain and dyspnea (56.7 %). Additional diagnostic laboratory tests were commonly performed (CRP: 47.7 %, natriuretic peptides: 25.6 %, d-dimer: 21.5 %). Most common diagnoses were musculoskeletal symptoms (21.6 %) and coronary heart disease (7.1 %; 1.1 % ACS). Troponin testing showed sensitivity and specificity of 77.8 % (60.9–89.9) and 94.3 % (93.5–95.1), respectively. Negative and positive predictive values were 99.7 (99.5–99.9) and 13.5 (11.1–16.4), and positive and negative likelihood ratios were 13.7 (10.9–17.1) and 0.24 (0.13–0.43). Conclusions GPs occasionally use troponin testing in very low-risk patients, often as part of a multi-marker rule-out strategy. The diagnostic characteristics of troponin tests, while promising, warrant prospective validation and implementation to facilitate appropriate use.

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Diagnosis and management of acute coronary syndrome in an outpatient setting: good guideline adherence in Swiss primary care

Cited by 2 publications

References 11 publications

Assessment of Adherence to ACC/AHA Guidelines in Primary Management of Patients With NSTEMI in a Referral Cardiology Hospital

Assessment of Adherence to ACC/AHA Guidelines in Primary Management of Patients With NSTEMI in a Referral Cardiology Hospital

Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area

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