Clinical investigationsPrediction of missed myocardial infarction among symptomatic outpatients without coronary heart disease☆
Section snippets
Study design
We performed a retrospective case-control study of patients with no previous history of CHD presenting to primary care physician practices with potential cardiac ischemia. Cases of missed myocardial infarction were identified from the malpractice claims files of the Controlled Risk Insurance Company (CRICO), which provides medical malpractice coverage for approximately 8000 physicians at Harvard University–affiliated clinical institutions. Missed diagnoses of myocardial infarction were found
Results
The 18 identified cases of missed myocardial infarction occurred in a variety of ambulatory settings including academic centers (n = 2, 11%), community practices (n = 8, 44%), and clinics affiliated with a large health maintenance organization (n = 8, 44%). Table Ishows the distribution of cardiac risk factors among the cases and matched controls. Patients in both groups were relatively young (mean ages: 50 years and 47 years). Cases were more likely to be men (67% vs 26%, P = .001), smokers
Discussion
We studied symptomatic patients with no previous history of CHD who experienced missed myocardial infarctions in the ambulatory setting and found that they were more likely than matched controls to have an elevated Diamond and Forrester probability of CHD and an elevated FRS. The association appears to be stronger with the FRS model than with the Diamond and Forrester model, as patients experienced a 12% increase in occurrence of missed MI for every 1% increase in FRS versus only a 3% increase
References (15)
- et al.
Litigation against the emergency physiciancommon features in cases of missed myocardial infarction
Ann Emerg Med
(1989) - et al.
Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room
Am J Cardiol
(1987) - et al.
Do patients' coronary risk factor reports predict acute cardiac ischemia in the emergency department? A multicenter study
J Clin Epidemiol
(1992) - et al.
Computer-assisted diagnosis in the noninvasive evaluation of patients with suspected coronary artery disease
J Am Coll Cardiol
(1983) - et al.
Cholesterol screening in an ED-based chest pain unit
Am J Emerg Med
(2002) - et al.
Immediate exercise testing of low risk patients with known coronary artery disease presenting to the emergency department with chest pain
J Am Coll Cardiol
(1999) - et al.
Missed diagnoses of acute cardiac ischemia in the emergency department
N Engl J Med
(2000)
Cited by (0)
- ☆
This work was supported by a grant from the Risk Management Foundation of the Harvard Medical Institutions. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.