Author(s): Ruigmez A, Rodrguez LA, Wallander MA, Johansson S, Jones R
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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.
This article was published in Fam Pract
and referenced in Journal of Health & Medical Informatics