Chest pain in general practice: incidence, comorbidity and mortality

Abstract

Background. Chest pain is a common symptom that presents the primary care physician with a complex diagnostic and therapeutic challenge.

Aims. To evaluate the natural history and management of patients diagnosed with chest pain of unspecified type or origin in primary care.

Design. Population-based case–control study.

Methods. The study included 13 740 patients with a first diagnosis of unspecified chest pain and 20 000 age- and sex-matched controls identified from the UK General Practice Research Database. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression. Risk estimates were adjusted for age, sex and number of physician visits.

Results. The incidence of a new diagnosis of chest pain was 15.5 per 1000 person-years and increased with age, particularly in men. The risk of a chest pain diagnosis was greatest in patients with prior diagnoses of coronary heart disease (OR: 7.1; 95% CI: 6.1–8.2) and gastroesophageal reflux disease (OR: 2.0; 95% CI: 1.7–2.3). In the year after diagnosis, chest pain patients were more likely than controls to be newly diagnosed with coronary heart disease (OR: 14.9; 95% CI: 12.7–17.4) and heart failure (OR: 4.7; 95% CI: 3.6–6.1). A new diagnosis of chest pain was associated with an increased risk of death in the following year (RR: 2.3; 95% CI: 1.9–2.8).

Conclusions. Some causes of chest pain are underdiagnosed in primary care. This is of particular consequence for the minority of chest pain patients with cardiac disease.

Chest pain, automated database, population-based sudy, primary care, incidence