NHG-Standaard Acuut coronair syndroom

Rutten, FH; Grundmeijer, H. G. L. M.; Grijseels, EWM; Bentum, STB Van; Hendrick, JMA; Bouma, M; Eizenga, W; Pinxteren, B. van

doi:10.1007/978-90-313-8279-8_17

Cited by 6 publications

(3 citation statements)

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“…In general practices randomised to the control group, included patients will receive standard care in accordance with the Dutch GP guideline for ACS 19. Standard care consists of a medical history and physical examination by the GP.…”

Section: Methods and Analysismentioning

confidence: 99%

Ruling out acute coronary syndrome in primary care with a clinical decision rule and a capillary, high-sensitive troponin I point of care test: study protocol of a diagnostic RCT in the Netherlands (POB HELP)

Bulk¹,

Petrus²,

Willemsen³

et al. 2023

BMJ Open

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IntroductionChest pain is a common reason for consultation in primary care. To rule out acute coronary syndrome (ACS), general practitioners (GP) refer 40%–70% of patients with chest pain to the emergency department (ED). Only 10%–20% of those referred, are diagnosed with ACS. A clinical decision rule, including a high-sensitive cardiac troponin-I point-of-care test (hs-cTnI-POCT), may safely rule out ACS in primary care. Being able to safely rule out ACS at the GP level reduces referrals and thereby alleviates the burden on the ED. Moreover, prompt feedback to the patients may reduce anxiety and stress.Methods and analysisThe POB HELP study is a clustered randomised controlled diagnostic trial investigating the (cost-)effectiveness and diagnostic accuracy of a primary care decision rule for acute chest pain, consisting of the Marburg Heart Score combined with a hs-cTnI-POCT (limit of detection 1.6 ng/L, 99th percentile 23 ng/L, cut-off value between negative and positive used in this study 3.8 ng/L). General practices are 2:1 randomised to the intervention group (clinical decision rule) or control group (regular care). In total 1500 patients with acute chest pain are planned to be included by GPs in three regions in The Netherlands. Primary endpoints are the number of hospital referrals and the diagnostic accuracy of the decision rule 24 hours, 6 weeks and 6 months after inclusion.Ethics and disseminationThe medical ethics committee Leiden-Den Haag-Delft (the Netherlands) has approved this trial. Written informed consent will be obtained from all participating patients. The results of this trial will be disseminated in one main paper and additional papers on secondary endpoints and subgroup analyses.Trial registration numbersNL9525 andNCT05827237.

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Section: Methods and Analysismentioning

confidence: 99%

Ruling out acute coronary syndrome in primary care with a clinical decision rule and a capillary, high-sensitive troponin I point of care test: study protocol of a diagnostic RCT in the Netherlands (POB HELP)

Bulk¹,

Petrus²,

Willemsen³

et al. 2023

BMJ Open

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“…As ACS encompasses unstable angina pectoris and acute myocardial infarction (AMI), rapid diagnosis or exclusion of ACS is crucial to allow initiation of effective evidence-based treatment and management (Authors/Task Force Members et al , 2015). As a patient’s signs and symptoms alone are often insufficient to rule out AMI in general practices (Bruyninckx et al , 2008), ~29% of all patients presenting with chest pain in the GP’s office are immediately referred (Okkes et al , 2005), while the estimated incidence of a cardiovascular problem among those patients is relatively low (8–15%) (Buntinx et al , 2001; Nilsson et al , 2003; Ruigomez et al , 2006; Bosner et al , 2009; Rutten et al , 2012). This suggests that between six out of seven and 11 out of 12 patients are referred to the hospital without having ACS.…”

Section: Introductionmentioning

confidence: 99%

“…AMI in general practices (Bruyninckx et al, 2008), 29% of all patients presenting with chest pain in the GP's office are immediately referred (Okkes et al, 2005), while the estimated incidence of a cardiovascular problem among those patients is relatively low (8-15%) (Buntinx et al, 2001;Nilsson et al, 2003;Ruigomez et al, 2006;Bosner et al, 2009;Rutten et al, 2012). This suggests that between six out of seven and 11 out of 12 patients are referred to the hospital without having ACS.…”

mentioning

confidence: 99%

Improving early exclusion of acute coronary syndrome in primary care: the added value of point-of-care troponin as stated by general practitioners

Kip

Noltes

Koffijberg

et al. 2017

Prim Health Care Res Dev

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An online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015. Findings A total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.

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