Key result
The incidence of new non-acute chest pain in primary care was 1.01 per 1000 patient-years, with low referral rates (24%) and suboptimal post-referral communication and pharmacological guideline adherence.
Why the study?
Optimizing care and resource use for patients with non-acute chest pain required more information on current incidence, referral rates, and management in primary care.
Cohort (n=9,029)
Yes
In primary care, communication from cardiologists back to GPs and subsequent secondary prevention prescribing for stable angina are frequently suboptimal, highlighting a gap in the continuity of cardiovascular care.
Low incidence with 24% referral and frequent missing cardiologist correspondence signals care gaps; leaves open optimal primary care strategies for non-acute chest pain.
BACKGROUND: The prevalence of coronary artery disease is increasing due to the aging population and increasing prevalence of cardiovascular risk factors. Non-acute chest pain often is the first symptom of stable coronary artery disease. To optimise care for patients with non-acute chest pain and make efficient use of available resources, we need to know more about the current incidence, referral rate and management of these patients. METHODS: We used routinely collected health data from the STIZON data warehouse in the Netherlands between 2010 and 2016. Patients > 18 years, with no history of cardiovascular disease, seen by the general practitioner (GP) for non-acute chest pain with a suspected cardiac origin were included. Outcomes were (i) incidence of new non-acute chest pain in primary care, (ii) referral rates to the cardiologist, (iii) correspondence from the cardiologist to the GP, (iv) registration by GPs of received correspondence and; (v) pharmacological guideline adherence after newly diagnosed stable angina pectoris. RESULTS: In total 9029 patients were included during the study period, resulting in an incidence of new non-acute chest pain of 1.01/1000 patient-years. 2166 (24%) patients were referred to the cardiologist. In 857/2114 (41%) referred patients, correspondence from the cardiologist was not available in the GP's electronic medical record. In 753/1257 (60%) patients with available correspondence, the GP did not code the conclusion in the electronic medical record. Despite guideline recommendations, 37/255 (15%) patients with angina pectoris were not prescribed antiplatelet therapy nor anticoagulation, 69/255 (27%) no statin and 67/255 (26%) no beta-blocker. CONCLUSION: After referral, both communication from cardiologists and registration of the final diagnosis by GPs were suboptimal. Both cardiologists and GPs should make adequate communication and registration a priority, as it improves health outcomes. Secondary pharmacological prevention in patients with angina pectoris was below guideline standards. So, proactive attention needs to be given to optimise secondary prevention in this high-risk group in primary care.
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Bulk et al. (2022) conducted a cohort in Non-acute chest pain (n=9,029). Primary care presentation for non-acute chest pain was evaluated on Incidence of new non-acute chest pain in primary care. The incidence of new non-acute chest pain in primary care was 1.01 per 1000 patient-years, with low referral rates (24%) and suboptimal post-referral communication and pharmacological guideline adherence.
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