Key result
Patients discharged with unexplained chest pain had a high 1-year incidence of CHD and experienced mortality rates 45-53% higher than the general population for those under 65 years of age.
Why the study?
Evaluating the prognosis of patients with unexplained chest pain provides valuable information for the evaluation of health services.
What is the 1-year incidence of CHD, CVD, and mortality in patients discharged with unexplained chest pain compared to the general population?
Cohort (n=59,569)
Yes
What is the 1-year incidence of CHD, CVD, and mortality in patients discharged with unexplained chest pain compared to the general population?
Patients discharged with unexplained chest pain have a significantly higher 1-year mortality rate compared to the general population, largely driven by non-cardiovascular causes in those under 65.
Unexplained chest pain warrants closer surveillance in younger patients; leaves open whether targeted interventions reduce excess CHD and mortality.
BACKGROUND: The prognosis of unexplained chest pain patients provides valuable information for evaluation of health services. OBJECTIVE: To examine prognosis of unexplained chest pain. METHODS: Using data from in- and outpatient hospital visits in Norway of patients discharged with a main diagnosis of unexplained chest pain (ICD-10: R072-R074) in 2010-2012, the 1-year incidence of coronary heart disease (CHD), any cardio-vascular disease (CVD) and mortality was evaluated. Cases with prior 2-year history of CVD or chest pain were excluded. Cox proportional hazards evaluated outcomes by patient characteristics and standardized mortality ratios evaluated observed versus expected mortality. RESULTS: Of 59 569 patients identified (20-89 years of age), the majority (86%) were referred to hospital by out-of-hours emergency care centres. Subsequent CHD was noted for 12.5%, 19.5% and 25.0% of men and 7.2%, 11.0%, 14.0% of women aged 45-64, 65-74 and 75-89 years, respectively. The per cent of deaths attributed to CVD were greatest within the first 2 months of postdischarge. Total mortality rates (per 1000 person-years) were 6.6 in men and 4.7 in women aged 45-64 and 69.2 in men and 39.5 in women aged 75-89 years. Relative to the general population, mortality was 53% and 45% higher for men and women under 65 years of age, respectively, attributed primarily to non-CVD causes. CONCLUSION: Patients in Norway discharged with unexplained chest pain are an at-risk group in terms of incident CHD, any CVD and mortality, including non-CVD mortality during the first-year postdischarge. The results suggest that unexplained chest pain patients may benefit from greater healthcare coordination between medical disciplines.
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Egeland et al. (2019) conducted a cohort in Unexplained chest pain (n=59,569). Unexplained chest pain vs. General population was evaluated on 1-year incidence of coronary heart disease (CHD), any cardio-vascular disease (CVD) and mortality. Patients discharged with unexplained chest pain had a high 1-year incidence of CHD and experienced mortality rates 45-53% higher than the general population for those under 65 years of age.