July 14, 2011

Coronary Heart Disease Goes Unrecognized

Of 180 patients in this study in whom a reference committee later identified coronary heart disease (CHD), 31.7% had originally been misdiagnosed by their family doctors as not having CHD ("false negative"). Stefan Bösner and his colleagues present the results of their cross-sectional study in the current edition of Deutsches Óžrzteblatt International (Dtsch Arztebl Int 2011; 108[26]: 445-51).

When a patient presents with chest pain as the main symptom, the family doctor has to decide whether immediate action is called for or whether watchful waiting is an option. In this diagnostic cross-sectional study the authors evaluated the data of a total of 1249 patients over the age of 35 years who presented to 74 participating family doctors with chest pain. From this data pool, Bösner and colleagues extracted the doctors' initial suspected diagnosis in respect of coronary heart disease (CHD). In a total of 57 patients the doctor wrongly suspected another cause than CHD for the chest pain. Nevertheless, the family doctors still referred one in three of the patients given such a false negative diagnosis to a cardiologist. In view of the number of missed cases of CHD, there is an argument for considering a diagnosis of CHD in patients with less pronounced symptoms. However, the researchers believe that if the "diagnostic threshold" were to be lowered, the result would be a dramatic rise in false positive diagnoses.


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