Long‐Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study
Background Most adults presenting with chest pain will not receive a diagnosis and be recorded with unattributed chest pain. The objective was to assess if they have increased risk of cardiovascular disease compared with those with noncoronary chest pain and determine whether investigations and inte...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.023146 |
| _version_ | 1797849617454333952 |
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| author | Kelvin P. Jordan Trishna Rathod‐Mistry James Bailey Ying Chen Lorna Clarson Spiros Denaxas Richard A. Hayward Harry Hemingway Danielle A. van der Windt Mamas A. Mamas |
| author_facet | Kelvin P. Jordan Trishna Rathod‐Mistry James Bailey Ying Chen Lorna Clarson Spiros Denaxas Richard A. Hayward Harry Hemingway Danielle A. van der Windt Mamas A. Mamas |
| author_sort | Kelvin P. Jordan |
| collection | DOAJ |
| description | Background Most adults presenting with chest pain will not receive a diagnosis and be recorded with unattributed chest pain. The objective was to assess if they have increased risk of cardiovascular disease compared with those with noncoronary chest pain and determine whether investigations and interventions are targeted at those at highest risk. Methods and Results We used records from general practices in England linked to hospitalization and mortality information. The study population included patients aged 18 years or over with a new record of chest pain with a noncoronary cause or unattributed between 2002 and 2018, and no cardiovascular disease recorded up to 6 months (diagnostic window) afterward. We compared risk of a future cardiovascular event by type of chest pain, adjusting for cardiovascular risk factors and alternative explanations for chest pain. We determined prevalence of cardiac diagnostic investigations and preventative medication during the diagnostic window in patients with estimated cardiovascular risk ≥10%. There were 375 240 patients with unattributed chest pain (245 329 noncoronary chest pain). There was an increased risk of cardiovascular events for patients with unattributed chest pain, highest in the first year (hazard ratio, 1.25 [95% CI, 1.21–1.29]), persistent up to 10 years. Patients with unattributed chest pain had consistently increased risk of myocardial infarction over time but no increased risk of stroke. Thirty percent of patients at higher risk were prescribed lipid‐lowering medication. Conclusions Patients presenting to primary care with unattributed chest pain are at increased risk of cardiovascular events. Primary prevention to reduce cardiovascular events appears suboptimal in those at higher risk. |
| first_indexed | 2024-04-09T18:46:58Z |
| format | Article |
| id | doaj.art-1dce941a1de74d87b19037eee4a1013c |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T18:46:58Z |
| publishDate | 2022-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-1dce941a1de74d87b19037eee4a1013c2023-04-10T11:57:34ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-04-0111710.1161/JAHA.121.023146Long‐Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record StudyKelvin P. Jordan0Trishna Rathod‐Mistry1James Bailey2Ying Chen3Lorna Clarson4Spiros Denaxas5Richard A. Hayward6Harry Hemingway7Danielle A. van der Windt8Mamas A. Mamas9School of Medicine Keele University Keele United KingdomSchool of Medicine Keele University Keele United KingdomSchool of Medicine Keele University Keele United KingdomSchool of Medicine Keele University Keele United KingdomSchool of Medicine Keele University Keele United KingdomInstitute of Health InformaticsUniversity College London London United KingdomSchool of Medicine Keele University Keele United KingdomInstitute of Health InformaticsUniversity College London London United KingdomSchool of Medicine Keele University Keele United KingdomKeele Cardiovascular Research Group School of Medicine Keele University Keele United KingdomBackground Most adults presenting with chest pain will not receive a diagnosis and be recorded with unattributed chest pain. The objective was to assess if they have increased risk of cardiovascular disease compared with those with noncoronary chest pain and determine whether investigations and interventions are targeted at those at highest risk. Methods and Results We used records from general practices in England linked to hospitalization and mortality information. The study population included patients aged 18 years or over with a new record of chest pain with a noncoronary cause or unattributed between 2002 and 2018, and no cardiovascular disease recorded up to 6 months (diagnostic window) afterward. We compared risk of a future cardiovascular event by type of chest pain, adjusting for cardiovascular risk factors and alternative explanations for chest pain. We determined prevalence of cardiac diagnostic investigations and preventative medication during the diagnostic window in patients with estimated cardiovascular risk ≥10%. There were 375 240 patients with unattributed chest pain (245 329 noncoronary chest pain). There was an increased risk of cardiovascular events for patients with unattributed chest pain, highest in the first year (hazard ratio, 1.25 [95% CI, 1.21–1.29]), persistent up to 10 years. Patients with unattributed chest pain had consistently increased risk of myocardial infarction over time but no increased risk of stroke. Thirty percent of patients at higher risk were prescribed lipid‐lowering medication. Conclusions Patients presenting to primary care with unattributed chest pain are at increased risk of cardiovascular events. Primary prevention to reduce cardiovascular events appears suboptimal in those at higher risk.https://www.ahajournals.org/doi/10.1161/JAHA.121.023146cardiovascular diseasechest painelectronic health recordsprimary care |
| spellingShingle | Kelvin P. Jordan Trishna Rathod‐Mistry James Bailey Ying Chen Lorna Clarson Spiros Denaxas Richard A. Hayward Harry Hemingway Danielle A. van der Windt Mamas A. Mamas Long‐Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular disease chest pain electronic health records primary care |
| title | Long‐Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study |
| title_full | Long‐Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study |
| title_fullStr | Long‐Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study |
| title_full_unstemmed | Long‐Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study |
| title_short | Long‐Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study |
| title_sort | long term cardiovascular risk and management of patients recorded in primary care with unattributed chest pain an electronic health record study |
| topic | cardiovascular disease chest pain electronic health records primary care |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.023146 |
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