Chest pain in primary care: Epidemiology and pre-work-up probabilities

Abstract

Background/objective: Chest pain is a common complaint and reason for consultation. We aimed to study the epidemiology of chest pain with respect to underlying aetiologies and to establish pre-work-up probabilities for the primary care setting. Methods: We included 1212 consecutive patients with chest pain, aged 35 years and older, attending 74 general practitioners (GPs). GPs recorded symptoms and fi ndings of each patient and provided follow-up information. An independent interdisciplinary reference panel reviewed clinical data of every patient and decided on the aetiology of chest pain at the time of patient recruitment. Results: The prevalence of chest pain among all attending patients was 0.7%. The majority (55.9%) of patients were women. Mean age was 59 (35-93) years. Of these patients, 53.2% had chest pains at the time of consultation and 29.6% presented with acute (Ͻ 48 hours' duration) chest pain. Pain originating from the chest wall was diagnosed in 46.6% of all patients, stable ischaemic heart disease (IHD) in 11.1%, and psychogenic disorders in 9.5%; 3.6% had acute coronary syndrome (ACS). Conclusion:The study adds important information about the epidemiology of chest pain as a frequent reason for consulting primary care practitioners. We provide updated pre-work-up probabilities for IHD for each age and sex category.

Accuracy of General Practitioners’ Assessment of Chest Pain Patients for Coronary Heart Disease in Primary Care: Cross-sectional Study with Follow-up

“…Chest pain can be caused by a wide range of different illnesses, among which lifethreatening cardiac disease is of the greatest immediate concern (1,2). However, chest pain is caused by coronary heart disease (CHD) in only around 12-15% of primary care patients (3)(4)(5). For most of patients with chest pain, the GP remains the main point of entry into the health care system.…”

Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule

“…Although the underlying aetiology in the majority of patients is noncardiac, for example, musculoskeletal, psychological, or oesophageal, coronary heart disease (CHD) accounts for 8.0-14.6% of chest pain cases in this setting. [1][2][3] GPs must reliably identify serious cardiac disease while also protecting patients from unnecessary investigations and hospital admissions. Based on the results of the medical interview and physical examination, the GP determines the probability of CHD and decides whether additional tests or treatment are needed.…”

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule

“…[1][2][3] While the underlying aetiology in the majority of patients is non-cardiac (for example, musculoskeletal, psychological, oesophageal), coronary heart disease (CHD) accounts for 12.8-14.6 % of cases of chest pain in this setting. 2,3 GPs must reliably identify serious cardiac disease, while also protecting patients from unnecessary investigations and hospital admissions. Based on medical history taking and physical examination, they decide whether further diagnostic procedures are indicated.…”