Managing anginal chest pain in primary care: A qualitative analysis with perspectives from general practitioners

Aim. The aim of this study was to gain insight into general practitioners' (GPs') modus operandi, by investigating the experiences of GPs regarding the assessment of anginal chest pain. Introduction. Assessing anginal chest pain in primary care is hampered by a presentation that is often different from text-books and by limited diagnostic tools. Methods. We conducted a qualitative, semi-structured interview-based study among GPs in the Netherlands regarding diagnosis, classification, referral, treatment and guideline adherence in anginal chest pain. Findings & conclusions. We interviewed 16 GPs. They expressed challenges in classification of chest pain, including determining its typicality and distinguishing stable from unstable chest pain. These uncertainties, combined with the limited direct access to diagnostics in primary care, lead to diversity in diagnostics approach, treatment and referrals of patients with anginal chest pain, next to doubts regarding the guideline's referral criteria. This lead GPs to combine guideline adherence with personal experience and intuition in dealing with anginal chest pain. GPs aim to balance avoiding unnecessary referrals with minimizing missing chronic coronary syndrome diagnoses, resulting in diverse anginal chest pain management strategies in primary care. GPs emphasize the need for improvements in diagnostics and advanced reassurance methods to safely and effectively exclude severe disease.