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Defining delayed and missed diagnosis of acute and chronic coronary syndromes: a modified Delphi consensus method

Dinah L Van Schalkwijk1, Anna S M Dobbe2, Paula M C Mommersteeg1

  • 1Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands.

Open Heart
|April 21, 2026
PubMed

Insights

Researchers developed consensus-based definitions for delayed and missed coronary artery disease (CAD) diagnosis in acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). This framework aids future research into CAD diagnostic delays.

Area of Science:

  • Cardiology
  • Diagnostic Medicine
  • Health Services Research

Background:

  • Delayed and missed diagnoses of coronary artery disease (CAD) lack clear definitions, hindering epidemiological research.
  • Understanding these diagnostic delays is crucial for improving patient outcomes in acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).

Purpose of the Study:

  • To establish consensus-based definitions for delayed and missed diagnoses in both ACS and CCS.
  • To provide a foundation for future research on the epidemiology and determinants of diagnostic delays in CAD.

Main Methods:

  • A modified Delphi method was employed, involving a diverse panel of healthcare professionals, patients, and healthy citizens.
  • Multiple rounds of definition development and expert grading using Likert scales were conducted to achieve consensus.

Main Results:

  • Numerous definitions for delayed and missed ACS and CCS were generated and evaluated.
  • Specific definitions were recommended based on predefined consensus criteria (IQR, median, convergence), with varying levels of recommendation (highly recommended, recommended, considerable).

Conclusions:

  • A single, universal definition for delayed/missed ACS/CCS diagnosis was not achieved due to the complexity of CAD diagnostic pathways.
  • The consensus-based framework and recommended definitions offer a valuable resource for standardizing future research and enhancing understanding of diagnostic delays.
Abstract

Keywords:
Acute Coronary SyndromeAngina PectorisEpidemiologyQuality of Health Care

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