The accuracy of general practitioners' clinical assessment of chest pain patients.
OBJECTIVE
To study general practitioners' (GP) assessment of the probability of ischaemic heart disease (IHD) and GP action in daily practice regarding chest pain patients.


METHODS
All chest pain patients aged 20-79 years, attending three primary health-care centres in south-east Sweden and assessed by the GP to have high, low or very low probability of IHD, were included consecutively over a two year period. The "GP action in daily practice" was classed as "active decisions" (investigation or treatment) or "wait and see". "IHD" or "not IHD" was settled according to the results of acute hospital investigation or exercise testing/myocardial perfusion scintigraphy.


RESULTS
516 patients were included, 93 high, 145 low and 278 very low probability cases. The outcome was "IHD" in 47%, 9% and 1% respectively. The sensitivity and specificity of the "GP assessment of the probability of IHD" were 72% and 89%. The sensitivity and specificity of the "GP action in daily practice" were 88% and 72%, respectively. The negative predictive value was 98%.


CONCLUSIONS
GP assessment, after clinical evaluation, that the probability of IHD was low did not safely rule out IHD. GP action in daily practice however, indicates that general practice is an appropriate level of care for chest pain patients.
Nilsson
Staffan
S
General Practice, Department of Medical and Health Sciences, Faculty of Health Sciences, Linkoping, Sweden. staffan.nilsson@lio.se
Ortoft
Kjell
K
Mölstad
Sigvard
S
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D002983:Clinical Competence / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013548:Sweden