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- Title
Non-acute chest pain in primary care; referral rates, communication and guideline adherence: a cohort study using routinely collected health data.
- Authors
van den Bulk, Simone; Spoelman, Wouter A.; van Dijkman, Paul R. M.; Numans, Mattijs E.; Bonten, Tobias N.
- Abstract
Background: The prevalence of coronary artery disease is increasing due to the aging population and increasing prevalence of cardiovascular risk factors. Non-acute chest pain often is the first symptom of stable coronary artery disease. To optimise care for patients with non-acute chest pain and make efficient use of available resources, we need to know more about the current incidence, referral rate and management of these patients. Methods: We used routinely collected health data from the STIZON data warehouse in the Netherlands between 2010 and 2016. Patients > 18 years, with no history of cardiovascular disease, seen by the general practitioner (GP) for non-acute chest pain with a suspected cardiac origin were included. Outcomes were (i) incidence of new non-acute chest pain in primary care, (ii) referral rates to the cardiologist, (iii) correspondence from the cardiologist to the GP, (iv) registration by GPs of received correspondence and; (v) pharmacological guideline adherence after newly diagnosed stable angina pectoris. Results: In total 9029 patients were included during the study period, resulting in an incidence of new non-acute chest pain of 1.01/1000 patient-years. 2166 (24%) patients were referred to the cardiologist. In 857/2114 (41%) referred patients, correspondence from the cardiologist was not available in the GP's electronic medical record. In 753/1257 (60%) patients with available correspondence, the GP did not code the conclusion in the electronic medical record. Despite guideline recommendations, 37/255 (15%) patients with angina pectoris were not prescribed antiplatelet therapy nor anticoagulation, 69/255 (27%) no statin and 67/255 (26%) no beta-blocker. Conclusion: After referral, both communication from cardiologists and registration of the final diagnosis by GPs were suboptimal. Both cardiologists and GPs should make adequate communication and registration a priority, as it improves health outcomes. Secondary pharmacological prevention in patients with angina pectoris was below guideline standards. So, proactive attention needs to be given to optimise secondary prevention in this high-risk group in primary care.
- Subjects
NETHERLANDS; SCIENTIFIC observation; CARDIOLOGISTS; DISEASE incidence; ANGINA pectoris; PRIMARY health care; MEDICAL protocols; CHEST pain; MEDICAL referrals; INTERPROFESSIONAL relations; COMMUNICATION; CORONARY artery disease; DESCRIPTIVE statistics; RESEARCH funding; PAIN management; LONGITUDINAL method; SYMPTOMS
- Publication
BMC Primary Care, 2022, Vol 23, Issue 1, p1
- ISSN
2731-4553
- Publication type
Article
- DOI
10.1186/s12875-022-01939-w