title: The diagnosis of coronary heart disease in a low-prevalence setting: follow-up data from patients whose CHD was misdiagnosed by their family doctors.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  For 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%).
  
  
  CONCLUSIONS
  Primary 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.
authors.affiliation: Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Universität Marburg, Germany. boesner@staff.uni-marburg.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Bösner
authors.forename: Jörg
authors.initials: J
authors.lastname: Haasenritter
authors.forename: Heidi
authors.initials: H
authors.lastname: Keller
authors.forename: Maren
authors.initials: M
authors.lastname: Abu Hani
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Sönnichsen
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology; D003299:Cooperative Behavior; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D008875:Middle Aged; D010348:Patient Care Team; D011336:Probability; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies