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Chest pain in family practice. Diagnosis and long-term outcome in a community setting
A E Svavarsdóttir1, M R Jónasson, G H Gudmundsson
1Fossvogur Health Centre in Reykjavík, Iceland.
Insights
Family doctors can effectively diagnose chest pain causes, differentiating serious conditions from benign ones. This study highlights the importance of history-taking in primary care for accurate chest pain diagnosis.
Area of Science:
- Primary Care Medicine
- Cardiology
- Diagnostic Accuracy
Background:
- Chest pain is a common presenting complaint in primary care.
- Accurate diagnosis is crucial to rule out serious cardiac conditions.
- Family practice settings require efficient diagnostic strategies.
Purpose of the Study:
- To determine the diagnostic distribution of chest pain in an urban family practice.
- To evaluate the outcomes of patients presenting with chest pain.
- To assess the diagnostic methods used in primary care for chest pain.
Main Methods:
- Retrospective chart review of chest pain patients at an urban family practice.
- Analysis of diagnostic distribution, investigations, and treatments.
- Long-term follow-up (3-4 years) to assess patient well-being and identify missed diagnoses.
Main Results:
- Musculoskeletal pain was the most common diagnosis (48.9%).
- Heart diseases accounted for 17.9% of diagnoses.
- History was key for musculoskeletal pain; cardiac cases received more investigations. No serious diseases were missed despite limited lab use.
Conclusions:
- Family physicians effectively differentiate serious from benign chest pain causes.
- Clinical judgment and targeted investigations are sufficient in many cases.
- Primary care diagnostic approaches for chest pain are reliable.
Objective:
To describe diagnostic distribution and outcome of chest pain among patients attending an urban family practice.
Design:
Retrospective, descriptive chart review.
Setting:
Primary care practice.
Participants:
All patients contacts for chest pain at Fossvogur Health Centre in the years 1989 and 1990 (193 contacts with 189 patients) were examined. One patient died before follow up and two could not be reached for follow up; they were excluded from the study. Of the 190 contacts and 186 patients studied, one patient who had two contacts with the clinic died during the study.
Main Outcome Measures:
Age and sex distribution, physical examination, investigations, diagnosis, and treatment; well-being of every patient was checked 3 to 4 years after initial contact. We asked about evolution of symptoms and looked for possible misdiagnosis.
Results:
Musculoskeletal pain was diagnosed in 48.9% of contacts, heart diseases in 17.9% and 9.5% had undiagnosed chest pain. The history was the main diagnostic tool for patients with musculoskeletal diseases, while patients with heart diseases were examined more carefully and underwent more diagnostic procedures. Follow up showed that no serious disease had been missed in spite of restrictive use of laboratory investigations.
Conclusions:
The working methods of family doctors who examined patients with chest pain in this health centre can differentiate between patients with serious diseases and those with benign conditions.