University of Twente Student Theses


Study to the clinical outcomes and compliance of Fast Track Poli 'chest pain’ patients on the long term

Kok, Melanie (2018) Study to the clinical outcomes and compliance of Fast Track Poli 'chest pain’ patients on the long term.

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Abstract:Background – Ziekenhuisgroep Twente (ZGT)’s cardiology department started with the Fast Track Poli “chest pain” (FTP) in September 2009. Although the FTP delivers outstanding results regarding to the speed of diagnosing and assessing patients with chest pain with mild to moderate suspicion of coronary heart diseases, clinical utility of the FTP department is not investigated. Therefore this study aims to map long-term clinical outcomes and differences in these clinical outcomes between patients with different FTP outcomes; FTP related tests and scores which best predict long-term clinical outcomes; and long-term compliance. Methods – This retrospective, cross-sectional study used questionnaires and was performed in 1000 Dutch patients who visited the FTP between 2009 and 2015. Descriptive analyses were performed to study long-term clinical outcomes and to which extent they differed for patients with different FTP outcomes; and long-term compliance to stop smoking and diet advice. Univariate and multivariate Cox Proportional Hazard analyses were performed to find the diagnostic- and/or prognostic test(s) and/or score(s) within the FTP pathway which best predicted long-term clinical outcomes. Results – Mean patient age was 54.8±10.5 years and 61.9% was male (n=519) at baseline. Of the 505 respondents (60.3%), 0.6% (n=3) had a cardiac related death; 0.4% (n=2) had a myocardial infarction (MI); 5.1% (n=26) had a coronary artery bypass grafting (CABG); 7.3% (n=37) had a percutaneous coronary intervention (PCI); 0.4% (n=2) had a heart valve surgery; 3.0% (n=15) had a cardiac related rehospitalisation; and 6.3% (n=32) had a cardiac related referral after their FTP visit. Significantly higher rates were found in respondents with diagnosed high-grade stenosis on the FTP (p<0.001). The Framingham score (p=0.030) and the CTCA (p<0.001) were the most accurate predictors of cardiac related death, MI, CABG, PCI, and heart valve surgery. The pre-test probability of CHD (p=0.049), the coronary artery calcium score (p=0.037), and the CTCA (p<0.001) were the best predictors when cardiac related rehospitalisation and -referral were also included as endpoints. 32.8% (22/67) of the respondents stopped smoking as a result of FTP lifestyle advice. Compliance to diet advice was much better with 93.3% (125/134). Discussion – The results suggest clinical utility of the FTP as it showed (1) low CHD risk after FTP visit; (2) predictive accuracy of the Framingham score, the pre-test probability of CHD, and the coronary artery calcium score in combination with the CTCA; and (3) relative good compliance on the long term. It should be mentioned that respondents appeared to be not representative for nonrespondents within this study. Future studies should focus on patient satisfaction and long-term results of regular diagnostics in the Netherlands to prove clinical utility of the FTP in Dutch patients with chest pain.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Health Sciences MSc (66851)
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