Chest pain and ischaemic heart disease in primary care
Insights
The incidence of ischaemic heart disease (IHD) in patients presenting with chest pain to general practitioners is low. Eight percent of patients received an IHD diagnosis, with further investigation needed for some.
Area of Science:
- Cardiology
- General Practice
- Epidemiology
Background:
- Chest pain is a primary symptom for new ischaemic heart disease (IHD) presentations.
- Limited data exists on the incidence of IHD in patients consulting general practitioners (GPs) for chest pain.
Purpose of the Study:
- To determine the occurrence of IHD in patients presenting with chest pain.
- To evaluate bicycle exercise test results for diagnosing IHD.
- To estimate the population incidence of IHD.
Main Methods:
- Prospective descriptive study conducted in three primary health centers in south-eastern Sweden.
- Inclusion of consecutive patients aged 20-79 without prior IHD diagnosis presenting with new chest pain.
- Outcome classification based on questionnaires, exercise tests, and hospital care data; retrospective analysis of hospital registry for IHD diagnoses.
Main Results:
- Out of 38,075 GP consultations, 577 (1.5%) were for chest pain.
- IHD was diagnosed in 8% of chest pain patients; diagnosis was excluded in 83% and uncertain in 9%.
- Yearly IHD incidence was 6.5 diagnosed cases per 1000 inhabitants (aged 20-79).
Conclusions:
- The incidence of new chest pain episodes prompting GP visits is low.
- 8% of patients presenting with chest pain were diagnosed with IHD.
- 9% of patients required further investigation or clinical assessment for uncertain IHD diagnosis.
Background:
Chest pain is the main symptom of first presentation with ischaemic heart disease (IHD). Little is known about the incidence of IHD among patients consulting the general practitioner (GP) for chest pain.
Aims:
To estimate the occurrence of IHD among patients consulting for chest pain, to study the results of the bicycle exercise test, and to estimate the incidence of IHD in the population.
Design Of Study:
Prospective descriptive study.
Setting:
Three primary health centres in south-eastern Sweden.
Method:
All patients without a current IHD diagnosis, aged 20 to 79 years, and consulting for a new episode of chest pain, were included consecutively. The outcome was classified as IHD, possible IHD or not IHD, according to the results of a postal questionnaire, an exercise test or hospital care. Data from the hospital registry on patients with a diagnosis of IHD were analysed retrospectively.
Results:
Out of 38,075 GP consultations, 577 (1.5%) were for chest pain. IHD was diagnosed in 41 (8%) of the chest pain patients, in 441 (83%) the diagnosis was excluded, and in 50 (9%) the diagnosis was judged as being uncertain. Even though the diagnostic criteria were strict, the exercise tests led to a diagnostic conclusion in 77% of the cases, most frequently a normal test result. Combining data from primary and hospital care, the yearly incidence of IHD was 6.5 diagnosed per 1000 inhabitants (aged 20 to 79 years old).
Conclusion:
The incidence of a new episode of chest pain bringing the patients to the GP was low. Eight per cent of the patients received an IHD diagnosis, and in 9% further investigation or clinical assessment is needed.
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