ArticleBJGP open2018
The conundrum of acute chest pain in general practice: a nationwide survey in The Netherlands.
Article in BJGP open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 20 citations in OpenAlex.
- Pooled it
- Pooled it
- Chest Pain in Primary Care: A Systematic Review of Risk Stratification Tools to Rule Out Acute Coronary Syndrome.Annals of family medicinePooled it
- Trial
- The HEART-GP strategy for ruling out acute coronary syndrome in out-of-hours primary care: a diagnostic accuracy trial protocol.Contemporary clinical trials communications · 2026Article
- Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts.Open heart · 2025Article
- Chest pain in a multi-ethnic population: A community-based study on sex differences in chest pain prevalence and care contacts.International journal of cardiology. Cardiovascular risk and prevention · 2025Article
- Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study.BMC primary care · 2025Article
- Telephone triage of chest pain in out-of-hours primary care: external validation of a symptom-based prediction rule to rule out acute coronary syndromes.Family practice · 2024Article
- Article
- Evaluation of telephone triage among chest pain patients in out-of-hours primary care in the Netherlands (TRACE).Family practice · 2023Observational
- Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting.BMC health services research · 2022Article
- Article
- Performance of a simplified HEART score and HEART-GP score for evaluating chest pain in urgent primary care.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2021Article
- Rationale and design of a cohort study evaluating triage of acute chest pain in out-of-hours primary care in the Netherlands (TRACE).Primary health care research & development · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGPs are frequently confronted with patients with acute onset chest pain. Although usually benign, approximately 5% is due to acute coronary syndrome (ACS). Unfortunately, ACS is not always recognised, leading to a missed diagnosis in 2-5% of presentations.
aimThe authors set out to study the level of risk GPs are willing to accept with regards to missing an ACS diagnosis, and the receptiveness of implementing new clinical decision aids. DESIGN &
settingThis study involved an online survey among GPs in the Netherlands.
methodA concept survey was constructed, which was tested among a panel of 24 GPs. The survey was then modified to achieve content validity. This survey was electronically distributed among 1000 GPs.
resultsA total of 313 (31.3%) GPs completed the survey. Of those surveyed, the median age was 50 years (interquartile range 41-57), 53.0% were female, and 6.4% were specialist GPs ('kaderarts') in cardiology or acute care. GPs estimated the missed ACS rate to be <5.0% in clinical practice, most often estimating a chance of 1.0-2.5% (35.2%) or 0.5-1.0% (29.7%). For atypical case presentations, 70% of GPs would accept a 0.1-1.0% missed diagnosis rate, while keeping the referral threshold to a maximum of 50 unnecessary referrals for each ACS case (75% of responders). GPs would welcome additional decision aids, with 79.2% favouring a clinical decision aid, 77.1% favouring troponin point-of-care (POC) testing, and 85.5% favoring a combination of a clinical decision aid and a troponin POC test.
conclusionGPs perceive that they miss more ACS cases than they feel comfortable with, which is reflected in a defensive referral strategy. The vast majority of GPs would welcome the use of clinical decision aids and/or cardiac biomarker POC testing for ruling out ACS, if accompanied by more certainty than based on clinical judgment alone.
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