An exploratory report of chest pain in primary care. A report from ASPN

Chest pain is important to patients and clinicians because it can signal a threat to life as well as present diagnostic and therapeutic challenges. Because prior clinical research has not provided clear guidance to primary care clinicians, the Ambulatory Sentinel Practice Network was interested in investigating chest pain as it presents and is managed in primary care. A contemporary exploratory study was required to characterize chest pain from a clinical perspective, to test the feasibility of investigating chest pain in a network of primary care practices, and to generate promising areas for investigation. This article provides a detailed distribution of demographic, diagnostic, and therapeutic variables associated with a convenience sample of 832 patients with chest pain. Most of the patients in this study were seen only by primary care clinicians in office settings. There were promising areas identified for further investigation, including an unexpected frequency of costochondritis in black women, clinician uncertainty in the management of patients with chest pain thought to be of gastrointestinal origin, constant vigilance for infrequent myocardial infarctions, perceived discordance between clinician and patient concerning the patient's chest pain, and the methodological requirement of improved delineation of episodes of chest pain.