Accuracy of symptoms and signs for coronary heart disease assessed in primary care.
BACKGROUND
Diagnosing the aetiology of chest pain is challenging. There is still a lack of data on the diagnostic accuracy of signs and symptoms for acute coronary events in low-prevalence settings.


OBJECTIVE
To evaluate the diagnostic accuracy of symptoms and signs in patients presenting to general practice with chest pain.


METHODS
Cross-sectional diagnostic study with delayed-type reference standard.


METHODS
Seventy-four general practices in Germany.


METHODS
The study included 1249 consecutive patients presenting with chest pain. Data were reviewed by an independent reference panel, with coronary heart disease (CHD) and an indication for urgent hospital admission as reference conditions. Main outcome measures were sensitivity, specificity, likelihood ratio, predictive value, and odds ratio (OR) for non-trauma patients with a reference diagnosis.


RESULTS
Several signs and symptoms showed strong associations with CHD, including known vascular disease (OR = 5.13; 95% confidence interval [CI] = 2.83 to 9.30), pain worse on exercise (OR = 4.27; 95% CI = 2.31 to 7.88), patient assumes cardiac origin of pain (OR = 3.20; 95% CI = 1.53 to 6.60), cough present (OR = 0.08; 95% CI = 0.01 to 0.77), and pain reproducible on palpation (OR = 0.27; 95% CI = 0.13 to 0.56). For urgent hospital admission, effective criteria included pain radiating to the left arm (OR = 8.81; 95% CI = 2.58 to 30.05), known clinical vascular disease (OR = 7.50; 95% CI = 2.88 to 19.55), home visit requested (OR = 7.31; 95% CI = 2.27 to 23.57), and known heart failure (OR = 3.53; 95% CI = 1.14 to 10.96).


CONCLUSIONS
Although individual criteria were only moderately effective, in combination they can help to decide about further management of patients with chest pain in primary care.
Department of General Practice/Family Medicine, University of Marburg, Germany. boesner@staff.uni-marburg.de
Stefan
S
Bösner
Annette
A
Becker
Maren
M
Abu Hani
Heidi
H
Keller
Andreas C
AC
Sönnichsen
Jörg
J
Haasenritter
Konstantinos
K
Karatolios
Juergen R
JR
Schaefer
Erika
E
Baum
Norbert
N
Donner-Banzhoff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D004812:Epidemiologic Methods; D005194:Family Practice; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D012015:Reference Standards