Prevalence and treatment of chest pain syndromes, hypertension and high LDL-cholesterol in primary care

Abstract The aims of this study are (1) to evaluate the performance of current triage for chest pain; (2) to describe the case mix of patients undergoing triage for chest pain; and (3) to identify opportunities to improve performance of current Dutch triage system for chest pain. Chest pain is a common symptom, and identifying patients with chest pain that require urgent care can be quite challenging. Making the correct assessment is even harder during telephone triage. Temporal trends show that the referral threshold has lowered over time, resulting in overcrowding of first responders and emergency services. While various stakeholders advocate for a more efficient triage system, careful evaluation of the performance of the current triage in primary care is lacking. TRiage of Acute Chest pain Evaluation in primary care (TRACE) is a large cohort study designed to describe the current Dutch triage system for chest pain and subsequently evaluate triage performance in regard to clinical outcomes. The study consists of consecutive patients who contacted the out-of-hours primary care facility with chest pain in the region of Alkmaar, the Netherlands, in 2017, with follow-up for clinical outcomes out to August 2019. The primary outcome of interest is ‘major event’, which is defined as the occurrence of death from any cause, acute coronary syndrome, urgent coronary revascularization, or other high-risk diagnoses in which delay is inadmissible and hospitalization is necessary. We will evaluate the performance of the triage system by assessing the ability of the triage system to correctly classify patients regarding urgency (accuracy), the proportion of safe actions following triage (safety) as well as rightfully deployed ambulances (efficacy). TRACE is designed to describe the current Dutch triage system for chest pain in primary care and to subsequently evaluate triage performance in regard to clinical outcomes.

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Recognising and treating arrhythmias in primary care

Practice Nursing ◽

10.12968/pnur.2019.30.6.270 ◽

2019 ◽

Vol 30 (6) ◽

pp. 270-275

Author(s):

Dave Richley

Keyword(s):

Primary Care ◽

Chest Pain ◽

Cardiac Arrhythmias ◽

Accurate Diagnosis ◽

Loss Of Consciousness ◽

Specialist Care ◽

Practice Nurses ◽

Erroneous Diagnosis ◽

The Uk ◽

Electrocardiogram Ecg

As more and more people in the UK are being affected by cardiovascular conditions, it is increasingly necessary for practice nurses to keep up-to-date with the latest developments. Dave Richley explains common ECG readings that may be seen in primary care Cardiac arrhythmias may be asymptomatic or they may be responsible for a range of symptoms including palpitations, dizziness, chest pain and loss of consciousness. Accurate diagnosis, and therefore appropriate management, depends on careful interpretation of an electrocardiogram (ECG) recording of the arrhythmia, and this is often achievable in primary care. This article presents the arrhythmias most commonly encountered in primary care, as well as those seen rarely, and describes and illustrates their defining features. It will also discuss some of the pitfalls that can lead to erroneous diagnosis. While some arrhythmias can be managed appropriately in primary care, guidance is provided in regarding referral or admission to hospital for arrhythmias that may warrant further investigation or specialist care.

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Controversies in Diagnostic Imaging of Patients With Suspected Stable and Acute Chest Pain Syndromes

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2019.05.009 ◽

2019 ◽

Vol 12 (7) ◽

pp. 1254-1278 ◽

Cited By ~ 2

Author(s):

Leslee J. Shaw ◽

Ron Blankstein ◽

David L. Brown ◽

Sanket S. Dhruva ◽

Pamela S. Douglas ◽

...

Keyword(s):

Chest Pain ◽

Diagnostic Imaging ◽

Acute Chest Pain ◽

Pain Syndromes

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Primary care use and cardiovascular disease risk in Russian 40–69 year olds: a cross-sectional study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-213549 ◽

2020 ◽

pp. jech-2019-213549

Author(s):

Jakob Petersen ◽

Anna Kontsevaya ◽

Martin McKee ◽

Erica Richardson ◽

Sarah Cook ◽

...

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

Chest Pain ◽

Russian Federation ◽

General Health ◽

Cross Sectional Study ◽

Health Check ◽

Sectional Study ◽

Cvd Risk ◽

Cross Sectional

BackgroundThe Russian Federation has very high cardiovascular disease (CVD) mortality rates compared with countries of similar economic development. This cross-sectional study compares the characteristics of CVD-free participants with and without recent primary care contact to ascertain their CVD risk and health status.MethodsA total of 2774 participants aged 40–69 years with no self-reported CVD history were selected from a population-based study conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015–2018. A range of co-variates related to socio-demographics, health and health behaviours were included. Recent primary care contact was defined as seeing primary care doctor in the past year or having attended a general health check under the 2013 Dispansarisation programme.ResultsThe proportion with no recent primary care contact was 32.3% (95% CI 29.7% to 35.0%) in males, 16.3% (95% CI 14.6% to 18.2%) in females, and 23.1% (95% CI 21.6% to 24.7%) overall. In gender-specific age-adjusted analyses, no recent contact was also associated with low education, smoking, very good to excellent self-rated health, no chest pain, CVD 10-year SCORE risk 5+%, absence of hypertension control, absence of hypertension awareness and absence of care-intensive conditions. Among those with no contact: 37% current smokers, 34% with 5+% 10-year CVD risk, 32% untreated hypertension, 20% non-anginal chest pain, 18% problem drinkers, 14% uncontrolled hypertension and 9% Grade 1–2 angina. The proportion without general health check attendance was 54.6%.ConclusionPrimary care and community interventions would be required to proactively reach sections of 40–69 year olds currently not in contact with primary care services to reduce their CVD risk through diagnosis, treatment, lifestyle recommendations and active follow-up.

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Systematic review and modeling of the investigation of acute and chronic chest pain presenting in primary care

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462305280194 ◽

2005 ◽

Vol 21 (1) ◽

pp. 148-149

Author(s):

J. Mant ◽

R. J. McManus ◽

R. A. L. Oakes ◽

B. C. Delaney ◽

P. M. Barton ◽

...

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Primary Care ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Early Management ◽

Coronary Syndrome ◽

Pain Clinics ◽

Exertional Angina ◽

Suspected Acute Myocardial Infarction

Objectives: The objectives were to ascertain the value of a range of methods—including clinical features, resting and exercise electrocardiography, and rapid access chest pain clinics (RACPCs)—used in the diagnosis and early management of acute coronary syndrome (ACS), suspected acute myocardial infarction (MI), and exertional angina.

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