New research points to evidence that general practitioners could be putting patients at a higher risk for severe cardiovascular outcomes by missing initial signs and symptoms for heart disease that could lead to an early diagnosis.

The research, published online in The Joint Commission Journal on Quality and Patient Safety, was conducted by CRICO Strategies, a research and analysis organization that insures Harvard-affiliated hospitals, and the Doctors Company, a medical malpractice insurance company in Napa, California.

The study included more than 250 closed medical malpractice cases in which patients alleged that a general medical practitioner in an outpatient setting failed to identify cardiovascular disease, according to a statement. These types of cases were more likely to result in patients suffering more severe injuries compared to other malpractice claims.

Initial data showed that nearly a quarter of the patients who were eventually diagnosed with myocardial infarction or coronary atherosclerosis had a history of heart disease. Additionally, most of the patients with missed coronary artery disease diagnoses received diagnoses that were similar but not as dangerous, such as esophageal reflux and musculoskeletal pain.

"What was most surprising from these results was cardiovascular malpractice claims in outpatient general medicine occur predominantly in patients with typical risk factors of cardiac disease rather than in low-risk patients," said Gene R. Quinn, MD, co-author of the study, in a statement. "In short, physicians aren't just missing the hard diagnoses."

Quinn and the other researchers recommend in the study that practitioners be more careful in diagnosing patients with conditions that initially appear to be something other than heart disease.

"We are proud to partner with CRICO on this important research that shines a light on risks that others may not see," said co-author Darrell Ranum, vice president of patient safety and risk management at The Doctors Company, in a statement. "These findings will help guide quality improvement efforts to decrease diagnostic error and improve patient safety. The next step is research into designing simple, scalable, and easily implemented interventions to prevent errors in diagnosis of patients at high risk of cardiac disease."