Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jun;60(575):e246-57.
doi: 10.3399/bjgp10X502137.

Accuracy of symptoms and signs for coronary heart disease assessed in primary care

Stefan Bösner  1 , Annette Becker, Maren Abu Hani, Heidi Keller, Andreas C Sönnichsen, Jörg Haasenritter, Konstantinos Karatolios, Juergen R Schaefer, Erika Baum, Norbert Donner-Banzhoff
Affiliations

Accuracy of symptoms and signs for coronary heart disease assessed in primary care

Stefan Bösner et al. Br J Gen Pract. 2010 Jun.

Abstract

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.

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

Design of study: Cross-sectional diagnostic study with delayed-type reference standard.

Setting: Seventy-four general practices in Germany.

Method: 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).

Conclusion: 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient flow: from number of consultations to cases for analysis (Sample I) and acute cases (Sample A).
Figure 2
Figure 2
Applying the recommendations (example).
See this image and copyright information in PMC

References

    1. Ruigomez A, Rodriguez LA, Wallander MA, et al. Chest pain in general practice: incidence, comorbidity and mortality. Fam Pract. 2006;23(2):167–174. - PubMed
    1. Svavarsdottir AE, Jonasson MR, Gudmundsson GH, Fjeldsted K. Chest pain in family practice. Diagnosis and long-term outcome in a community setting. Can Fam Physician. 1996;42:1122–1128. - PMC - PubMed
    1. Nilsson S, Scheike M, Engblom D, et al. Chest pain and ischaemic heart disease in primary care. Br J Gen Pract. 2003;53(490):378–382. - PMC - PubMed
    1. Verdon F, Burnand B, Herzig L, et al. Chest wall syndrome among primary care patients: a cohort study. BMC Fam Pract. 2007;12((8)):51. - PMC - PubMed
    1. Buntinx F, Knockaert D, Bruyninckx R, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18(6):586–589. - PubMed

Publication types