Primary care physicians are uncertain about diagnostic choices in patients with chest pain suggestive of ischemic heart disease. There are several reasons for this: 1) the accuracy of several noninvasive tests (exercise tolerance testing, exercise thallium scintigraphy, and exercise echocardiography) in primary care settings has yet to be established; 2) the value of clinical signs and symptoms for estimating the prior probability of coronary artery disease is unclear; 3) the utilities patients and physicians have for diagnostic information is unknown. This study seeks to improve the diagnosis and, therefore, the outcome of patients in the primary care system with suspected angina. We will prospectively enroll 500 patients from primary care physicians' offices in Rochester, New York. Each patient will have multiple noninvasive tests and the results will be interpreted blind to other tests. Some patients will go on to coronary angiography (as clinically indicated). All will be followed to determine their clinical course and functional status outcomes. The accuracy of the diagnostic tests will be calculated with reference to this information, utilizing ROC analysis. Data will also be collected about the value patients and physicians place on diagnostic information. A decision analysis will be used to determine the diagnostic approaches which are preferred based on expected outcomes and cost-effectiveness considerations in patients characterized by their presenting symptoms. Information from this project will be linked to that from the stable angina PORT project to develop guidelines for more informed diagnostic decision making in primary care settings. The impact of this should extend beyond diagnostic testing and lead to the more efficient use of percutaneous transluminal angioplasty, and coronary artery bypass graft surgery.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS006901-04
Application #
2235868
Study Section
Health Systems Research (HSR)
Program Officer
Cooper, James
Project Start
1992-09-30
Project End
1999-09-29
Budget Start
1995-09-30
Budget End
1999-09-29
Support Year
4
Fiscal Year
1995
Total Cost
Indirect Cost
Name
University of Rochester
Department
Public Health & Prev Medicine
Type
Schools of Dentistry
DUNS #
208469486
City
Rochester
State
NY
Country
United States
Zip Code
14627