A Nationwide Flash-Mob Study for Suspected Acute Coronary Syndrome

PURPOSE Our primary objective was to evaluate the Marburg Heart Score (MHS), a clinical decision rule, or to develop an adapted clinical decision rule for family physicians (FPs) to safely rule out acute coronary syndrome (ACS) in patients referred to secondary care for suspected ACS. The secondary...

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Bibliographic Details
Published in:Annals of family medicine 2019-07, Vol.17 (4), p.296
Main Authors: Angel M.R. Schols, Robert T. A. Willemsen, Tobias N. Bonten, Martijn H. Rutten, Patricia M. Stassen, Bas L. J. H. Kietselaer, Geert-Jan Dinant, Jochen W.L. Cals
Format: Article
Language:English
Subjects:
Acute coronary syndrome
Diagnosis
Health screening
Medical research
Methods
Primary health care
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Summary:PURPOSE Our primary objective was to evaluate the Marburg Heart Score (MHS), a clinical decision rule, or to develop an adapted clinical decision rule for family physicians (FPs) to safely rule out acute coronary syndrome (ACS) in patients referred to secondary care for suspected ACS. The secondary objective was to evaluate the feasibility of using the flash-mob method, an innovative study design, for large-scale research in family medicine. METHODS In this 2-week, nationwide, prospective, observational, flash-mob study, FPs collected data on possible ACS predictors and assessed ACS probability (on a scale of 1-10) in patients referred to secondary care for suspected ACS. RESULTS We collected data for 258 patients in 2 weeks by mobilizing approximately 1 in 5 FPs throughout the country via ambassadors. A final diagnosis was obtained for 243 patients (94.2%), of whom 45 (18.5%) received a diagnosis of ACS. Sex, sex-adjusted age, and ischemic changes on electrocardiography were significantly associated with ACS. The sensitivity of the MHS (cut-off [less than or equal to] 2) was 75.0%, specificity was 44.0%, positive predictive value was 24.3%, and negative predictive value was 88.0%. For the FP assessment (cut-off [less than or equal to] 5), these test characteristics were 86.7%, 41.4%, 25.2%, and 93.2%, respectively. CONCLUSIONS For patients referred to emergency care, ACS could not be safely ruled out using the MHS or FP clinical assessment. The flash-mob study design may be a feasible alternative research method to investigate relatively simple, clinically relevant research questions in family medicine on a large scale and over a relatively short time frame.
ISSN:1544-1709
DOI:10.1370/afm.2401.