Presentation, management and course of angina and suspected angina in primary care

Previous surveys may have underestimated both prevalence and incidence of i schemic heart disease in general practice. Case identification is difficult , as many patients presenting with chest pain turn out not to have ischemic heart disease, although their outcome is unclear otherwise. In this work w e aimed to: (1) estimate prevalence and incidence of angina in one Oxford g eneral practice; (2) describe the processes of assessment, investigation, a nd management of suspected angina; and (3) describe the 2-year symptomatic and functional outcome of angina patients, compared with patients whose pro visional diagnosis of suspected ischemic heart disease (IHD) was not subseq uently sustained (NCCP). A retrospective survey of patients was undertaken (aged 45-74 years) by hand searching paper and electronic medical records t o find, as of 1 January 1992, all patients in the practice with continuing treatment of angina diagnosed before 1989, or those having a new diagnosis of angina being assessed (suspected angina) in the 3 years 1989-1991. Two y ears later, a postal questionnaire survey compared the symptomatic and func tional outcome of confirmed IHD and NCCP. On 1 January 1992, the diagnosis of angina was recorded in the notes of 11.1% of patients aged 45-74 years, and the diagnosis was considered correct in 7.4%. Over a 3-year period, 129 people were suspected of suffering from angina, but in 71 (55%) the diagno sis was not confirmed; 76 (59%) were either referred to a specialist out-pa tient clinic or had an emergency admission. A 2-year follow-up found that s imilar proportions of patients with angina and noncardiac chest pain had a poor outcome in terms of symptoms, mental state, quality of everyday life. and continuing consultation. The clinical burden of ischemic heart disease in general practice has been underestimated by earlier methodological appro aches using less complete ascertainment strategies. The adequacy of current diagnostic and management arrangements for patients with suspected angina merits review, at both the primary and secondary care levels. (C) 1999 Else vier Science Inc.