Chest pain: to refer or not to refer?

Every day in the Netherlands, 1400 people with chest pain report to their general practitioner (GP). For the GP, it is sometimes difficult to determine whether or not the patients' complaints are caused by the heart. "A large percentage of the patients who are currently being referred to the cardiologist don't turn out to have heart complaints in the end. This leads to high healthcare costs as well as a high workload for cardiologists and creates unnecessary stress for the patient", explains LUMC lead researcher Tobias Bonten.

Refer or not?

In the POB-HELP study, Bonten is investigating whether a so-called decision rule can help in determining whether someone with chest pain should or should not be referred. He is conducting the research together with colleagues from the LUMC department of Cardiovascular Disease and researchers at Maastricht University, including GP Robert Willemsen.

The decision rule specifies that a general practitioner scores points and, if necessary, does a quick test. Based on the result, the GP should wait, consult with a cardiologist or refer the patient directly to the hospital. "If the GP can safely determine what the best strategy is with this type of decision-making assistance, then that means a great improvement for the GP and the patient", says Willemsen.

Savings of 60 million

The research is taking place in the regions of Leiden and Maastricht. Ninety general practices and five GP cooperatives are divided into two groups, half of which are using the new decision rule and half of which are not. The researchers take account of the number of referrals, the costs, the reassurance level of patients and whether no cardiac infarctions are missed with this method. Bonten: "If the decision rule works well, we expect ten percent fewer referrals to the hospital for chest pain. This would result in an annual savings of 60 million euros on a national scale."