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The value of signs, symptoms and plasma heart-type fatty acid-binding protein (H-FABP) in evaluating patients presenting with symptoms possibly matching acute coronary syndrome: background and methods of a diagnostic study in primary care

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@article{5442ed71ad564f48b4e1bbaa85f2b5d4,
title = "The value of signs, symptoms and plasma heart-type fatty acid-binding protein (H-FABP) in evaluating patients presenting with symptoms possibly matching acute coronary syndrome: background and methods of a diagnostic study in primary care",
abstract = "Background: Chest complaints presented to a general practitioner (GP) are frequently caused by diseases which have advantageous outcomes. However, in some cases, acute coronary syndrome (ACS) is present (1.5-22{\%} of cases). The patient's signs, symptoms and electrocardiography results are insufficient diagnostic tools to distinguish mild disease from ACS. Therefore, most patients presenting chest complaints are referred to secondary care facilities where ACS is then ruled out in a majority of patients (78{\%}). Recently, a point of care test for heart-type fatty acid-binding protein (H-FABP) using a low cut-off value between positive and negative of 4 ng/ml has become available. We aim to study the role of this point of care device in triage of patients presenting chest complaints possibly due to ACS, in primary care. Our research protocol is presented in this article. Results are expected in 2015.Methods/Design: Participating GPs will register signs and symptoms in all patients presenting chest complaints possibly due to ACS. Point of care H-FABP testing will also be performed. Our study will be a derivation study to identify signs and symptoms that, combined with point of care H-FABP testing, can be part of an algorithm to either confirm or rule out ACS. The diagnostic value for ACS of this algorithm in general practice will be determined.Discussion: A safe diagnostic elimination of ACS by application of the algorithm can be of significant clinical relevance. Improved triage and thus reduction of the number of patients with chest complaints without underlying ACS, that are referred to secondary care facilities, could lead to a substantial cost reduction.",
keywords = "Acute coronary syndrome (ACS), Acute myocardial infarction (AMI), Diagnostic study, Heart-type fatty acid-binding protein (H-FABP), Point of care test (PoCT), Primary care, ACUTE MYOCARDIAL-INFARCTION, RESPIRATORY-TRACT INFECTIONS, CLINICAL DECISION RULES, ACUTE CHEST-PAIN, GENERAL-PRACTICE, CONTROLLED-TRIAL, ACCURACY, EMERGENCY, METAANALYSIS, CLUSTER",
author = "R.T.A. Willemsen and F. Buntinx and B. Winkens and J.F. Glatz and G.J. Dinant and {'RAPIDA'-study team}, the",
year = "2014",
month = "12",
day = "12",
doi = "10.1186/s12875-014-0203-8",
language = "English",
volume = "15",
journal = "BMC Family Practice",
issn = "1471-2296",
publisher = "BioMed Central Ltd",

}

RIS

TY - JOUR

T1 - The value of signs, symptoms and plasma heart-type fatty acid-binding protein (H-FABP) in evaluating patients presenting with symptoms possibly matching acute coronary syndrome: background and methods of a diagnostic study in primary care

AU - Willemsen, R.T.A.

AU - Buntinx, F.

AU - Winkens, B.

AU - Glatz, J.F.

AU - Dinant, G.J.

AU - 'RAPIDA'-study team, the

PY - 2014/12/12

Y1 - 2014/12/12

N2 - Background: Chest complaints presented to a general practitioner (GP) are frequently caused by diseases which have advantageous outcomes. However, in some cases, acute coronary syndrome (ACS) is present (1.5-22% of cases). The patient's signs, symptoms and electrocardiography results are insufficient diagnostic tools to distinguish mild disease from ACS. Therefore, most patients presenting chest complaints are referred to secondary care facilities where ACS is then ruled out in a majority of patients (78%). Recently, a point of care test for heart-type fatty acid-binding protein (H-FABP) using a low cut-off value between positive and negative of 4 ng/ml has become available. We aim to study the role of this point of care device in triage of patients presenting chest complaints possibly due to ACS, in primary care. Our research protocol is presented in this article. Results are expected in 2015.Methods/Design: Participating GPs will register signs and symptoms in all patients presenting chest complaints possibly due to ACS. Point of care H-FABP testing will also be performed. Our study will be a derivation study to identify signs and symptoms that, combined with point of care H-FABP testing, can be part of an algorithm to either confirm or rule out ACS. The diagnostic value for ACS of this algorithm in general practice will be determined.Discussion: A safe diagnostic elimination of ACS by application of the algorithm can be of significant clinical relevance. Improved triage and thus reduction of the number of patients with chest complaints without underlying ACS, that are referred to secondary care facilities, could lead to a substantial cost reduction.

AB - Background: Chest complaints presented to a general practitioner (GP) are frequently caused by diseases which have advantageous outcomes. However, in some cases, acute coronary syndrome (ACS) is present (1.5-22% of cases). The patient's signs, symptoms and electrocardiography results are insufficient diagnostic tools to distinguish mild disease from ACS. Therefore, most patients presenting chest complaints are referred to secondary care facilities where ACS is then ruled out in a majority of patients (78%). Recently, a point of care test for heart-type fatty acid-binding protein (H-FABP) using a low cut-off value between positive and negative of 4 ng/ml has become available. We aim to study the role of this point of care device in triage of patients presenting chest complaints possibly due to ACS, in primary care. Our research protocol is presented in this article. Results are expected in 2015.Methods/Design: Participating GPs will register signs and symptoms in all patients presenting chest complaints possibly due to ACS. Point of care H-FABP testing will also be performed. Our study will be a derivation study to identify signs and symptoms that, combined with point of care H-FABP testing, can be part of an algorithm to either confirm or rule out ACS. The diagnostic value for ACS of this algorithm in general practice will be determined.Discussion: A safe diagnostic elimination of ACS by application of the algorithm can be of significant clinical relevance. Improved triage and thus reduction of the number of patients with chest complaints without underlying ACS, that are referred to secondary care facilities, could lead to a substantial cost reduction.

KW - Acute coronary syndrome (ACS)

KW - Acute myocardial infarction (AMI)

KW - Diagnostic study

KW - Heart-type fatty acid-binding protein (H-FABP)

KW - Point of care test (PoCT)

KW - Primary care

KW - ACUTE MYOCARDIAL-INFARCTION

KW - RESPIRATORY-TRACT INFECTIONS

KW - CLINICAL DECISION RULES

KW - ACUTE CHEST-PAIN

KW - GENERAL-PRACTICE

KW - CONTROLLED-TRIAL

KW - ACCURACY

KW - EMERGENCY

KW - METAANALYSIS

KW - CLUSTER

U2 - 10.1186/s12875-014-0203-8

DO - 10.1186/s12875-014-0203-8

M3 - Article

VL - 15

JO - BMC Family Practice

T2 - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

M1 - 203

ER -