Structured risk assessment and investigation of patients with chest pain i primary care - Refer to the right investigation, at the right time for the right patient and then prevent new events

Background:A structured risk assessment of chronic coronary artery disease based on the individual´s risk of disease is recommended by ESC.

In Region Östergötland, since 2021, primary care refer for computed tomography of the coronary arteries (CCTA) when low risk. For patients with intermediate to higher risk, exercise ECG are routine today. Traditionally, myocardial scintigraphy has been ordered by cardiologists.

It is not known how general practitioners approach more advanced investigations.Objective:Three workpackages (WP) studies:WP1- Is there a relationship between risk assessment and outcome of CCTA?WP2- Does the time to diagnosis differ and is it economically justifiable to investigate patients with a package investigation of more advanced modalities in comparison to the current routine?WP3- What is the general practitioner´s attitude to package investigation?Work plan:WP1 consists of a retrospective review of X-ray reports and data from the SWEDEHEART referred from primary care for CCTA.

Suspected significant coronary stenoses and further diagnostic outcome are analyzed.WP2 is based on a prospective randomized controlled study in which 500 patients who seek primary care with intermediate to higher risk-estimated chest pain are either investigated with the current routine or a package with myocardial scintigraphy, echocardiography and CCTA.WP3 is based on interview studies of general practitioners before the introduction of the package investigation and afterwards.