Chest pain and ischemic heart disease: Diagnosis and management in primary health care

In patients inquiring for chest pain, it’s crucial to judge the chance of ischemic heart disease (IHD). The goals in this dissertation were to examine the correctness of the general practitioners’ clinical assessments and the usefulness of exercise testing and myocardial perfusion scintigraphy (MPS) in individuals consulting for chest pain in primary care. Statins are acknowledged to prevent IHD. A further goal was therefore to research if a relation may be discovered on a population basis involving the usage of statins and the morbidity of acute myocardial infarction (AMI). Methods. All patients from 20 to 79 years, consulting for a new episode of chest pain in 3 major health care centres, were included during almost 2 yrs from 1998 to 2000. The patients were managed based on the clinical evaluation. The existence of IHD was ruled out either by clinical examination only, or if stable IHD was in question, by exercise testing and if the exercise test was inconclusive by an additional MPS. If unstable IHD or myocardial infarction was suspected, referral for emergency hospital examination was made. Correlations between statin sales and the morbidity of AMI in Sweden’s municipalities were analysed in an ecological, register based study. Realignment was made for sales of antidiabetics, socio-economic deprivation indexes and geographic coordinates…


Epidemiology of chest pain and ischemic heart disease
In the world
In Sweden
In hospital care
In primary care
Diagnostic methods of ischemic heart disease in primary care
Clinical assessment
Biochemical tests
Exercise test
Myocardial perfusion scintigraphy
Diagnostic management in primary care
Stable angina
AMI or unstable angina
Atypical chest pain
Risk factors and prevention of ischemic heart disease
Plasma lipids
Other risk factors
Prevention of ischemic heart disease
General aim
Specific aims
Populations (I, II, III)
Inclusion criteria
Exclusion criteria
Populations (IV)
Methods (I, II, III)
Data collection (I, II, III)
Hospital medical records (I, III)
Data from a hospital diagnosis registry (I)
Postal questionnaire (I)
Exercise testing (I, II, III)
Myocardial perfusion scintigraphy (II, III)
Methods (IV)
Statistical methods
Patients (I, III)
Patients (II)
IHD as the cause of chest pain was excluded by the GPs’ clinical
evaluation (I)
Results of follow up
Stable IHD as the cause of chest pain could not be excluded (I, II, III)
Results after investigation and follow up
Exercise test and myocardial perfusion scintigraphy (II)
Unstable IHD or AMI could not be excluded (I, III)
Results after investigation and follow up
The GPs’ assessment of chest pain patients (III)
Statin sales and AMI‐morbidity in Sweden between 1998 and 2002 (IV)
The epidemiology of chest pain and ischemic heart disease in primary care
Diagnosing ischemic heart disease
Exercise testing
Myocardial perfusion scintigraphy…

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