Hospitalised patients with unexplained chest pain: incidence and prognosis

J Intern Med. 2019 Nov;286(5):562-572. doi: 10.1111/joim.12948. Epub 2019 Jul 19.

Abstract

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.

Keywords: cardiovascular disease; chest pain; incidence; mortality; socio-economic status.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Chest Pain / diagnosis*
  • Chest Pain / mortality*
  • Educational Status
  • Female
  • Hospitalization*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Norway
  • Prognosis
  • Risk Factors
  • Young Adult