Kwok, CS ORCID: https://orcid.org/0000-0001-7047-1586, Bennett, S, Azam, Z, Welsh, V, Potluri, R, Loke, YK and Mallen, CD ORCID: https://orcid.org/0000-0002-2677-1028 (2021) Misdiagnosis of acute myocardial infarction: A systematic review of the literature. Critical Pathways in Cardiology.

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Abstract

Despite the availability of tests to diagnose acute myocardial infarction (AMI), cases are still missed. We systematic reviewed the literature to determine how missed AMI has been defined, the reported rates of misdiagnosed AMI, the outcomes patients with misdiagnosed AMI have, what diagnosis was initially suspected in missed AMI cases, and what factors are associated with misdiagnosed AMI. We searched MEDLINE and EMBASE in September 2020 for studies that evaluated missed AMI. Data was extracted from studies that met the inclusion criteria and the results were narratively synthesized. A total of 15 studies were included in this review. The number of patients with missed AMI in individual studies ranged from 64 to 4,707. There was no consistently used definition for misdiagnosed AMI but most studies reported rates of approximately 1-2%. Compared to AMI that was recognized, one study found no difference in mortality for misdiagnosed AMI at 30 days and 1 year. The common initial misdiagnoses that subsequently had AMI were ischemic heart disease, non-specific chest pain, gastrointestinal disease, musculoskeletal pain and arrhythmias. Reasons for missed AMI include incorrect electrocardiogram interpretation and failure to order appropriate diagnostic tests. Hospitals in rural areas and those with a low proportion of classical chest pain patients that turned out to have AMI were at greater risk of missed AMI. Misdiagnosed AMI is an unfortunate part of everyday clinical practice and better training in electrocardiogram interpretation and education about atypical presentations of AMI may reduce the number of misdiagnosed AMI.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Wolters Kluwer at doi: 10.1097/HPC.0000000000000256 - please refer to any applicable terms of use of the publisher.
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
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Depositing User: Symplectic
Date Deposited: 23 Mar 2021 11:16
Last Modified: 23 Mar 2021 11:16
URI: https://eprints.keele.ac.uk/id/eprint/9282

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