Chest pain without established ischaemic heart disease in primary care patients: associated comorbidities and mortality.
Br J Gen Pract. 2009 Mar;59(560):e78-86.
ABSTRACT AIMS: To assess morbidity and mortality following a new diagnosis of non-specific chest pain in patients without established IHD.
DESIGN OF STUDY: Population-based cohort study with nested case-control analysis.
SETTING: UK primary care practices contributing to the General Practice Research Database (GPRD).
METHODS: We selected chest pain patients aged 20-79 years from the General Practice Reseach Database who had no chest pain consultation before 2000 and had no IHD diagnosis before 2000 or within 2 weeks following the index date. The selected 3028 patients and matched controls were followed up for 1 year.
RESULTS: The incidence of chest pain in patients without established IHD was 12.7 per 1000 person-years. In the year following the index date, chest pain patients without established IHD were more likely than controls to receive a first IHD diagnosis (hazard ratio [HR]: 18.2; 95% confidence interval [CI]: 11.6-28.6) or to die (HR: 2.3; 95% CI: 1.3-4.1). Chest pain patients commonly had a history of gastroesophageal reflux disease (GORD; odds ratio [OR]: 2.0; 95% CI: 1.5-2.7) or went on to be diagnosed with GORD (risk ratio: 4.5; 95% CI: 3.1-6.4).
CONCLUSION: Patients with chest pain but without established IHD were found to have an increased risk of being diagnosed with IHD. Chest pain in patients without established IHD was also commonly associated with GORD.
BACKGROUND: Ischaemic heart disease (IHD) can be excluded in the majority of patients with unspecific chest pain. The remainder have what has generaly being called non-cardiac chest pain which has been associated with gastrointestinal, neuromusculoskeletal, pulmonary and psychiatric causes.