Correct diagnosis and treatment of chest pain can reduce fatal heart attacks. Jordan and colleagues report, in a paper published in BMJ, that patients who are not diagnosed with cardiovascular disease when they first report chest pain often go on to have more heart attacks.
Cardiovascular disease includes diseases that result from blocked or narrowed blood vessels. Cardiovascular disease often leads to heart attack and is one of the leading causes of death around the world. However, if caught early, cardiovascular disease is very treatable.
Chest pain is an early symptom of heart attack. Many patients are aware of this and will go see a doctor when they experience chest pain. As a result, the quick diagnosis and early treatment of chest pain is vital to reducing cardiovascular incidents. However, many doctors will only diagnose patients who they already consider to be at high risk of cardiovascular disease. Yet, many patients who exhibit chest pain but are not treated go on to have both fatal and non-fatal heart attacks.
To improve patient outcomes, we must understand how doctors diagnose and treat chest pain. Jordan and colleagues published a new research article in BMJ investigating the diagnosis and treatment of patients with first-time chest pain. The researchers also investigated whether patients who remained undiagnosed had worse outcomes.
The study included 172,180 adults who had reported first-time chest pain. The sample came from 223 different general practices offices in the UK, and relies on the UK’s electronic health record database CALIBER. The researchers measured the number of fatal or non-fatal cardiovascular events over a period of 5.5 years. They adjusted for other health issues, age, and sex. The researchers then compared three groups: those diagnosed with cardiovascular disease, those with non-cardiac chest pain, and those for whom chest pain was not attributed to any cause.
The cause of chest pain remained unattributed in 72.4% of patients. These patients were typically males under 65 years of age, with hypertension or obesity. On average, patients with unattributed chest pain experienced a cardiovascular event, such as a heart attack, within four or five months. In patients who had non-cardiac chest pain, this period was almost two years.
Patients with unattributed chest pain had much higher rates of heart attack (0.7%) than those with non-cardiac chest pains (0.1%). However, this rate was much lower than in patients diagnosed with cardiovascular disease (4.6%).
Only 11.7% of patients with unattributed chest pain received diagnostic care during the six months after their initial visit. In contrast, 31.5% of those who doctors diagnosed as having a cardiovascular condition received further care. However, patients with unattributed chest pain received treatment for high cholesterol, hypertension, or diabetes at higher rates (26.3%) than patients with non-cardiac chest pain (18.3%).
Early, correct diagnosis of the cause of chest pain can lead to early treatment of cardiovascular disease. Researchers will need to expand these findings to create models that predict which patients have the highest risk of heart attack. This will help general practitioners direct patients to treatment at the first sign of chest pain.
Written By: C. I. Villamil