Chest pain in general practice: incidence, comorbidity and mortality

Fam Pract. 2006 Apr;23(2):167-74. doi: 10.1093/fampra/cmi124. Epub 2006 Feb 3.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Case-Control Studies
  • Chest Pain / diagnosis
  • Chest Pain / epidemiology*
  • Chest Pain / mortality*
  • Child
  • Child, Preschool
  • Comorbidity*
  • Databases as Topic
  • Family Practice*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • State Medicine
  • United Kingdom / epidemiology