In primary care, when is chest pain due to coronary artery disease?

Stevens, R J; Lasserson, Daniel

doi:10.1503/cmaj.100808

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…-as a proxy variable. In contrast to common findings in prediction rule research, 7 the MHS showed a higher predictive power in this sample than in the derivation cohort. The AUC was 0.90 (95% CI = 0.87 to 0.93).…”

Section: Introductioncontrasting

confidence: 99%

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule

Haasenritter¹,

Bösner²,

Vaucher³

et al. 2012

Br J Gen Pract

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BackgroundThe Marburg Heart Score (MHS) aims to assist GPs in safely ruling out coronary heart disease (CHD) in patients presenting with chest pain, and to guide management decisions. AimTo investigate the diagnostic accuracy of the MHS in an independent sample and to evaluate the generalisability to new patients. Design and settingCross-sectional diagnostic study with delayedtype reference standard in general practice in Hesse, Germany. MethodFifty-six German GPs recruited 844 males and females aged ≥35 years, presenting between July 2009 and February 2010 with chest pain. Baseline data included the items of the MHS. Data on the subsequent course of chest pain, investigations, hospitalisations, and medication were collected over 6 months and were reviewed by an independent expert panel. CHD was the reference condition. Measures of diagnostic accuracy included the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, likelihood ratios, and predictive values. ResultsThe AUC was 0.84 (95% confidence interval [CI] = 0.80 to 0.88). For a cut-off value of 3, the MHS showed a sensitivity of 89.1% (95% CI = 81.1% to 94.0%), a specificity of 63.5% (95% CI = 60.0% to 66.9%), a positive predictive value of 23.3% (95% CI = 19.2% to 28.0%), and a negative predictive value of 97.9% (95% CI = 96.2% to 98.9%). ConclusionConsidering the diagnostic accuracy of the MHS, its generalisability, and ease of application, its use in clinical practice is recommended.Keywords chest pain; medical history taking; myocardial ischaemia; sensitivity and specificity.

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Section: Introductioncontrasting

confidence: 99%

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule

Haasenritter¹,

Bösner²,

Vaucher³

et al. 2012

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…It is also highly unlikely that practitioners would consider video consultations for patients who have a life-threatening medical emergency. This may stem from the perception of an increased risk of failing to make an appropriate diagnosis in this context and the need for immediate resuscitation of a patient with cardiac chest pain [21,22]. Consultations for patients with chronic mental health issues may also be hampered unless there are clear indications that such consultations are approved by colleagues and funding agencies.…”

Section: Discussionmentioning

confidence: 99%

Video Consultation Use by Australian General Practitioners: Video Vignette Study

Jiwa¹,

Meng²

2013

J Med Internet Res

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BackgroundThere is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy.ObjectiveThe aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems.MethodsOverall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation.ResultsA total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations.ConclusionsPatients with minor self-limiting illnesses and those with medical emergencies are unlikely to be offered access to a GP by video. The process of establishing video consultations as routine practice will need to be endorsed by senior members of the profession and funding organizations. Video consultation techniques will also need to be taught in medical schools.

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In primary care, when is chest pain due to coronary artery disease?

Cited by 2 publications

References 9 publications

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule

Video Consultation Use by Australian General Practitioners: Video Vignette Study

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