July 6, 2010
New Tool To Rule Out Coronary Heart Disease In Primary Care
A simple new rule can help primary care physicians rule out coronary heart disease in patients with chest pain, states a study published in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj100212.pdf.
Chest pain is common, yet it is challenging for primary care physicians to reliably identify serious cardiac disease while protecting patients from unnecessary interventions.The authors developed a clinical decision rule called the Primary Care CHD Score ("Marburg Heart Score") with five predictors that can be easily identified during a patient's visit: age/gender, known clinical vascular disease, pain worse with exercise, patient assumes cardiac origin of pain and pain not reproduced with palpitation.
"The aim of our study was to develop a simple, valid, and usable prediction score based on signs and symptoms to help physicians rule out coronary heart disease (CHD) in chest pain patients presenting in primary care," write Dr. Stefan Bösner, University of Marburg, Marburg, Germany and coauthors.
In a related commentary (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj100808.pdf, Richard Stevens and Daniel Lasserson of University of Oxford, UK, write "the challenge is correctly identifying and referring the patient with coronary heart disease while minimizing the number of referrals of patients who do not have CHD, to reduce the harm of unnecessary investigation and burden on healthcare resources." The authors suggest this decision rule shows promise for improving the diagnosis of CHD.
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