{"id":"46075","type":"article","url":"https://hartvaat.nl/2026/04/21/delphi-consensus-over-uitgestelde-en-gemiste-diagnose-van-coronairlijden/","title":"Delphi-consensus over 'uitgestelde' en 'gemiste' diagnose van coronairlijden","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003998?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003998?rss=1","authors":["Van Schalkwijk","D. L.","Dobbe","A. S. M.","Mommersteeg","P. M. C.","Erkelens","D. C.","Zwart","D. L. M.","Meeder","J. G.","Rutten","F. H.","On behalf of the IMPRESS Consortium"],"significance":5,"published":"2026-07-21","source_date":"2026-04-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/"],"congress":"","summary_en":"A clear definition of delayed or missed coronary artery disease (CAD) diagnosis is lacking, hampering research into its scale and causes. Using a modified Delphi method, a panel of cardiologists (19), general practitioners (35), patients (55) and healthy citizens (34) developed consensus definitions for two domains: acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). After four rounds, two definitions for delayed ACS were highly recommended and thirteen recommended; for missed ACS none reached the highest threshold. For CCS, two definitions for delayed diagnosis and one for missed diagnosis were highly recommended. No one-size-fits-all definition proved possible, reflecting the complexity and context-dependence of diagnostic pathways. The resulting framework and recommended definitions nonetheless provide a basis for comparable future research into delayed and missed CAD diagnoses.","created":"2026-07-03T20:27:15Z","updated":"2026-07-04T19:09:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een heldere definitie van een uitgestelde of gemiste diagnose van coronairlijden (CAD) ontbreekt, wat onderzoek naar de omvang en oorzaken bemoeilijkt. Met een gemodificeerde Delphi-methode ontwikkelde een panel van cardiologen (19), huisartsen (35), patiënten (55) en gezonde burgers (34) consensusdefinities voor twee domeinen: het acuut coronair syndroom (ACS) en het chronisch coronair syndroom (CCS). Na vier rondes werden voor uitgesteld ACS twee definities sterk aanbevolen en dertien aanbevolen; voor gemist ACS haalde geen enkele de hoogste drempel. Voor CCS werden voor uitgestelde diagnose twee en voor gemiste diagnose één definitie sterk aanbevolen. Er bleek geen universele definitie mogelijk, wat de complexiteit en contextafhankelijkheid van de diagnostische trajecten weerspiegelt. Het opgeleverde kader en de aanbevolen definities bieden niettemin een basis voor vergelijkbaar vervolgonderzoek naar uitgestelde en gemiste CAD-diagnoses.","abstract_original":"<sec><st>Objectives</st>\n<p>A clear definition of delayed and missed coronary artery disease (CAD) diagnosis is lacking, hampering research on the epidemiology and determinants of delayed and missed CAD diagnosis. We engaged healthcare professionals, patients and healthy citizens to develop a consensus-based definition of delayed and missed diagnosis in two CAD domains: acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).</p>\n</sec>\n<sec><st>Design</st>\n<p>Modified Delphi method.</p>\n</sec>\n<sec><st>Setting</st>\n<p>Primary and secondary care.</p>\n</sec>\n<sec><st>Participants</st>\n<p>The study was conducted among an expert panel consisting of cardiologists (n=19), general practitioners (n=35), patients (n=55) and healthy citizens (n=34).</p>\n</sec>\n<sec><st>Results</st>\n<p>42 definitions for delayed and missed ACS and 30 definitions for delayed and missed CCS were developed during the first 2 Delphi rounds. The expert panel graded these definitions in rounds 3 and 4 by Likert scale (from 1 (strongly disagree) to 5 (strongly agree)). Useful definitions for research purposes were recommended based on predefined criteria: (1) IQR to assess consensus, (2) median to evaluate the level of support for the definition and (3) convergence of the group to assess stability of opinions across rounds. For delayed ACS, 2 definitions were classified as highly recommended, 13 as recommended and 6 as considerable. For missed ACS, none met the threshold for highly recommended; 5 were recommended and 12 were classified as considerable. For CCS, 2 definitions for delayed diagnosis were highly recommended, 13 recommended and 7 considerable. For missed CCS, 1 definition was highly recommended, 6 were recommended and 7 were considerable.</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>We were unable to establish a one-size-fits-all definition for delayed and missed ACS/CCS diagnosis, reflecting the complexity and context-dependency of CAD diagnostic pathways. However, the developed consensus-based framework and recommended definitions provide a valuable basis for future research, enabling study comparisons across different diagnostic settings. This will ultimately enhance understanding of delayed and missed ACS/CCS diagnosis.</p>\n</sec>"}