[Free admission to stress electrocardiography with subsequent cardiological advice and feedback to the family physician: favorable effect on referral patterns].

OBJECTIVE

To improve the patient referral by general practitioners to the cardiology outpatient clinic for evaluation of (possibly) anginal complaints, by giving access to in-hospital bicycle exercise testing with cardiological advice and feedback.

DESIGN

Prospective.

SETTING

Department of non-invasive cardiology 'De Weezenlanden' Hospital, Zwolle, the Netherlands.

METHODS

Patients, with no cardiological history, were collected from two comparable groups of general practitioners: an experimental group (n = 90.000 patients), allowed to perform an in-hospital exercise test with concomitant advice of a cardiologist, and a reference group (n = 53.400 patients), who referred directly to the cardiologist without having this facility (as customary in the Dutch health care system). Data were collected prospectively from January 1st 1994 until May 1st 1995.

RESULTS

In the experimental group, 615 patients underwent exercise tests; 100 were subsequently referred. In addition, 53 patients were referred directly (total 153 patients; 1.3/1000 patients/year; 95% confidence interval: 1.1-1.5). In 51% of referred patients coronary disease was present, 37% underwent coronary angiography and 23% revascularisation (PTCA or CABG). During follow-up for 2 months no cardiovascular events occurred in non-referred patients. In the reference group, 132 patients were referred directly (1.9/1000 patients/ year; 1.6-2.2; p < 0.01 when compared with the experimental group). Of these patients 13% had coronary disease, 8% underwent coronary angiography and 3% revascularisation.

CONCLUSION

Free access to exercise testing with cardiological advice and feedback for general practitioners resulted in a reduction of referrals with improved efficiency.