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Managing chest pain patients in general practice: an interview-based study.

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General practitioners (GPs) report changing chest pain presentations, increasing uncertainty. They manage this through clinical judgment and cautiously await new diagnostic tools with proven value.

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Cardiovascular disordersDiagnostic testsGeneral practiceRisk assessmentUrgent care

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Area of Science:

  • General Practice
  • Cardiology
  • Diagnostic Tools

Background:

  • Chest pain assessment in general practice presents challenges and uncertainty for general practitioners (GPs).
  • The utility of novel diagnostic tools in managing chest pain remains uncertain.

Purpose of the Study:

  • To investigate changes in chest pain incidence and presentation encountered by GPs.
  • To understand how GPs manage professional uncertainty in chest pain cases.
  • To explore GPs' perspectives on new diagnostic tools, including their expectations and concerns.

Main Methods:

  • A qualitative study involving semi-structured interviews with general practitioners.
  • Explored six key areas: changes in chest pain prevalence, patient management, uncertainty, referral practices, attitudes towards referrals, and suggestions for improvement.

Main Results:

  • Interviews with 27 GPs indicated a decrease in acute coronary syndrome (ACS) cases among chest pain patients, alongside an increase in atypical presentations, leading to greater uncertainty.
  • GPs primarily rely on their own clinical judgment and expressed a need for new diagnostic tools only if their added value is clearly demonstrated.

Conclusions:

  • GPs perceive no decrease in chest pain incidence but note evolving presentations, contributing to professional uncertainty.
  • Over-referral for chest pain without acute coronary syndrome (ACS) is considered safe, and GPs are comfortable with this practice.
  • New diagnostic tools are approached with caution, with GPs emphasizing the need for proven clinical utility.