Chest pain in general practice: incidence, comorbidity and mortality. Ruigómez, A.; Rodríguez, L. A. G.; Wallander, M.; Johansson, S.; and Jones, R. Family Practice, 23(2):167--174, April, 2006.
doi  abstract   bibtex   
BACKGROUND: Chest pain is a common symptom that presents the primary care physician with a complex diagnostic and therapeutic challenge. AIMS: To evaluate the natural history and management of patients diagnosed with chest pain of unspecified type or origin in primary care. DESIGN: Population-based case-control study. METHODS: The study included 13,740 patients with a first diagnosis of unspecified chest pain and 20,000 age- and sex-matched controls identified from the UK General Practice Research Database. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression. Risk estimates were adjusted for age, sex and number of physician visits. RESULTS: The incidence of a new diagnosis of chest pain was 15.5 per 1000 person-years and increased with age, particularly in men. The risk of a chest pain diagnosis was greatest in patients with prior diagnoses of coronary heart disease (OR: 7.1; 95% CI: 6.1-8.2) and gastroesophageal reflux disease (OR: 2.0; 95% CI: 1.7-2.3). In the year after diagnosis, chest pain patients were more likely than controls to be newly diagnosed with coronary heart disease (OR: 14.9; 95% CI: 12.7-17.4) and heart failure (OR: 4.7; 95% CI: 3.6-6.1). A new diagnosis of chest pain was associated with an increased risk of death in the following year (RR: 2.3; 95% CI: 1.9-2.8). CONCLUSIONS: Some causes of chest pain are underdiagnosed in primary care. This is of particular consequence for the minority of chest pain patients with cardiac disease.
@article{ruigomez_chest_2006,
	title = {Chest pain in general practice: incidence, comorbidity and mortality},
	volume = {23},
	issn = {0263-2136},
	shorttitle = {Chest pain in general practice},
	doi = {10.1093/fampra/cmi124},
	abstract = {BACKGROUND: Chest pain is a common symptom that presents the primary care physician with a complex diagnostic and therapeutic challenge.
AIMS: To evaluate the natural history and management of patients diagnosed with chest pain of unspecified type or origin in primary care.
DESIGN: Population-based case-control study.
METHODS: The study included 13,740 patients with a first diagnosis of unspecified chest pain and 20,000 age- and sex-matched controls identified from the UK General Practice Research Database. Odds ratios (ORs) and 95\% confidence intervals (CIs) were computed using unconditional logistic regression. Risk estimates were adjusted for age, sex and number of physician visits.
RESULTS: The incidence of a new diagnosis of chest pain was 15.5 per 1000 person-years and increased with age, particularly in men. The risk of a chest pain diagnosis was greatest in patients with prior diagnoses of coronary heart disease (OR: 7.1; 95\% CI: 6.1-8.2) and gastroesophageal reflux disease (OR: 2.0; 95\% CI: 1.7-2.3). In the year after diagnosis, chest pain patients were more likely than controls to be newly diagnosed with coronary heart disease (OR: 14.9; 95\% CI: 12.7-17.4) and heart failure (OR: 4.7; 95\% CI: 3.6-6.1). A new diagnosis of chest pain was associated with an increased risk of death in the following year (RR: 2.3; 95\% CI: 1.9-2.8).
CONCLUSIONS: Some causes of chest pain are underdiagnosed in primary care. This is of particular consequence for the minority of chest pain patients with cardiac disease.},
	language = {eng},
	number = {2},
	journal = {Family Practice},
	author = {Ruigómez, Ana and Rodríguez, Luis Alberto García and Wallander, Mari-Ann and Johansson, Saga and Jones, Roger},
	month = apr,
	year = {2006},
	pmid = {16461444},
	keywords = {Adolescent, Adult, Aged, Case-Control Studies, Chest pain, Child, Child, Preschool, Comorbidity, Family Practice, Female, Great Britain, Humans, Longitudinal Studies, Male, Middle Aged, State Medicine, databases as topic},
	pages = {167--174}
}
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