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Primary Care Physicians Miss Signs of Cardiac Ischemia

About 11 percent of symptomatic patients aren't sent to the hospital before developing acute myocardial infarction

THURSDAY, Nov. 16 (HealthDay News) -- Primary care clinicians often miss early chances to send patients with cardiac ischemia to the hospital, researchers report in the Nov. 13 issue of the Archives of Internal Medicine. About 11 percent of acute myocardial infarction patients without a previous history of heart disease see their primary care doctor, nurse practitioner or physician's assistant for angina-like pain or other symptoms in the month before hospitalization, but aren't sent to the hospital.

Thomas D. Sequist, M.D., M.P.H., of Harvard Medical School in Boston, and colleagues analyzed data from 966 acute myocardial infarction patients without a prior history of heart disease. They found that 27 percent (261 patients) had seen their doctor in the previous month for chest pain. More than half of these patients were sent directly to the hospital (155 patients) and 41 percent were not (106/261, or 11 percent of the total). These patients were matched with three control patients with similar symptoms who did not develop acute myocardial infarction.

The researchers found that such "missed opportunities" were associated with a 10 percent or higher Framingham risk score (FRS), for a 19.5 odds ratio, as well as with higher scores involving the Diamond and Forrester forecasting instrument. Pain medications and antacids were most often prescribed

"We identified low prescription rates for beta-blocker and aspirin therapy among these symptomatic outpatients with elevated risk scores, and recent guidelines suggest aspirin therapy for patients with an elevated FRS even in the absence of symptoms," the authors write. "More aggressive intervention…may have prevented their acute myocardial infarction."

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