A clinical score plus bedside troponin ruled out heart attack in primary care chest pain

The edition in brief

In POB-HELP, a cluster-randomised diagnostic trial in Dutch general practice, GPs combined a five-item clinical score, the Marburg Heart Score, with a point-of-care high-sensitivity troponin I test for 740 patients with acute chest pain. The rule missed one acute coronary syndrome (sensitivity 98.3%, negative predictive value 99.7%) and no myocardial infarction, though it cleared only about half of patients and referral rates did not fall. A UK study in 67 practices found that simple tests, including a bladder diary, flow rate, residual volume and PSA, predicted bladder outlet obstruction well in men with lower urinary tract symptoms (c-index 0.82 in validation), but detrusor problems less well. A Swedish trial in 172 primary care patients with stress-related mental ill health found nurse-led collaborative care helped but did not meet its non-inferiority target against psychologist-guided CBT self-help. An Alberta study of chronic disease patients linked high clinic continuity with lower acute care costs, most for the most complex patients. The pearl: a three-day frequency-volume chart is the cheapest test in a man with urinary symptoms.