BACKGROUND: The diagnosis of coronary heart disease (CHD) is a challenge for primary care physicians (PCPs). We studied the further course of 57 patients who presented to their PCPs with chest pain and were initially misdiagnosed as not having CHD as the cause of chest pain. METHODS: The 57 misdiagnosed patients were among 1,249 consecutive patients aged 35 and above who presented with chest pain to 74 different PCPs (35% of the 209 PCPs initially invited to participate in the study). For each patient, the PCPs recorded the initial history and physical findings and the course over the ensuing six months. An independent interdisciplinary reference panel reviewed all of the data and retrospectively determined each patient's most likely cause of chest pain at the time of inclusion in the study. RESULTS: For 405 patients (32.4%), the PCPs rated the probability that CHD was the cause of chest pain at 0 to 5%. The reference panel retrospectively diagnosed CHD as the cause of chest pain in 180 patients. The PCPs correctly diagnosed CHD as the cause of chest pain in 123 (68.3%) of these patients and failed to diagnose CHD as the cause of chest pain in 57 of them (31.7%). 26 (45.6%) of the 57 misdiagnosed patients had a history of CHD. Even when the diagnosis of CHD as the cause of chest pain was missed, the PCPs often ordered an ECG (42 of 57 patients, or 73.7%) or referred the patient to a cardiologist or internist (20 of 57 patients, or 35.1%). CONCLUSION: Primary care physicians diagnose CHD with moderate sensitivity. Even when they initially fail to make the diagnosis, they often order further tests and consultations that ultimately lead to a correct diagnosis of CHD.
BACKGROUND: The diagnosis of coronary heart disease (CHD) is a challenge for primary care physicians (PCPs). We studied the further course of 57 patients who presented to their PCPs with chest pain and were initially misdiagnosed as not having CHD as the cause of chest pain. METHODS: The 57 misdiagnosed patients were among 1,249 consecutive patients aged 35 and above who presented with chest pain to 74 different PCPs (35% of the 209 PCPs initially invited to participate in the study). For each patient, the PCPs recorded the initial history and physical findings and the course over the ensuing six months. An independent interdisciplinary reference panel reviewed all of the data and retrospectively determined each patient's most likely cause of chest pain at the time of inclusion in the study. RESULTS: For 405 patients (32.4%), the PCPs rated the probability that CHD was the cause of chest pain at 0 to 5%. The reference panel retrospectively diagnosed CHD as the cause of chest pain in 180 patients. The PCPs correctly diagnosed CHD as the cause of chest pain in 123 (68.3%) of these patients and failed to diagnose CHD as the cause of chest pain in 57 of them (31.7%). 26 (45.6%) of the 57 misdiagnosed patients had a history of CHD. Even when the diagnosis of CHD as the cause of chest pain was missed, the PCPs often ordered an ECG (42 of 57 patients, or 73.7%) or referred the patient to a cardiologist or internist (20 of 57 patients, or 35.1%). CONCLUSION: Primary care physicians diagnose CHD with moderate sensitivity. Even when they initially fail to make the diagnosis, they often order further tests and consultations that ultimately lead to a correct diagnosis of CHD.
Authors: S Nilsson; M Scheike; D Engblom; L G Karlsson; S Mölstad; I Akerlind; K Ortoft; E Nylander Journal: Br J Gen Pract Date: 2003-05 Impact factor: 5.386
Authors: François Verdon; Lilli Herzig; Bernard Burnand; Thomas Bischoff; Alain Pécoud; Michel Junod; Nicole Mühlemann; Bernard Favrat Journal: Swiss Med Wkly Date: 2008-06-14 Impact factor: 2.193
Authors: Alexandre Ronga; Paul Vaucher; Jörg Haasenritter; Norbert Donner-Banzhoff; Stefan Bösner; François Verdon; Thomas Bischoff; Bernard Burnand; Bernard Favrat; Lilli Herzig Journal: BMC Fam Pract Date: 2012-08-06 Impact factor: 2.497