ArticleDeutsches Arzteblatt international2011
The diagnosis of coronary heart disease in a low-prevalence setting: follow-up data from patients whose CHD was misdiagnosed by their family doctors.
Article in Deutsches Arzteblatt international, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed, 6 citations in OpenAlex.
- Individual utilisation thresholds and exploring how GPs' knowledge of their patients affects diagnosis: a qualitative study in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Article
- Development and validation of a clinical prediction rule for chest wall syndrome in primary care.BMC family practice · 2012Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsThe 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.
resultsFor 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%).
conclusionPrimary 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.
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