ORIGINAL ARTICLE
Patients Dismissed From the Hospital With a Diagnosis of Noncardiac Chest Pain: Cardiac Outcomes and Health Care Utilization

https://doi.org/10.4065/mcp.2009.0428Get rights and content

OBJECTIVE

To determine the proportion of patients with noncardiac chest pain (NCCP) who see a gastroenterologist, the type and frequency of gastrointestinal (GI) and cardiac tests performed, and the frequency of cardiac death.

PATIENTS AND METHODS

A cohort of Olmsted County, Minnesota, residents presenting to the emergency department (ED) with chest pain between January 1, 1985, and December 31, 1992, was identified through the Rochester Epidemiology Project. We assessed the frequency of ED, cardiology, and gastroenterology visits and corresponding tests after a diagnosis of NCCP (n=320). We also assessed the frequency of cardiac events.

RESULTS

During follow-up, 49% of patients sought care in the ED, 42% had repeated cardiology evaluations, and 15% were seen by a gastroenterologist. Thirty-eight percent underwent esophagogastroduodenoscopy, but very few underwent manometry or a pH probe. Patients with NCCP of unknown origin had 3 times the rate of GI consultations as their counterparts with a GI disorder. Survival free of cardiac death in the subset with NCCP with a GI disorder was 90.2% at 10 years and 84.8% at 20 years, compared with 93.7% at 10 years and 88.1% at 20 years for the subset with NCCP of unknown origin.

CONCLUSION

The frequency of health care utilization in NCCP patients is high, but relatively few GI consultations and even fewer GI tests are performed. Patients dismissed from the hospital with NCCP continue to experience cardiac events, which may highlight a need for more aggressive cardiovascular risk factor management in this population.

Section snippets

PATIENTS AND METHODS

This study was approved by the Mayo Clinic Institutional Review Board. The population, previously defined by Prina et al,19 was identified through the Rochester Epidemiology Project, which provides access to almost all records of medical care provided to Olmsted County residents for the past 90 years. Patients were older than 18 years, resided in Olmsted County, and presented with acute chest pain to one of the county's 3 emergency departments (EDs) between January 1, 1985, and December 31,

RESULTS

The sample was 53% male (n=168) and 96% white. Mean ± age was 58±15 years. Mean ± SD Charlson comorbidity index was 3.8±3.5 (Table 1). Specific preexisting medicaldiagnoses and demographics were analyzed to estimate associations with NCCP-GI vs NCCP-U. The NCCP-GI group was slightly older (P<.01) and had a higher proportion of cardiac arrhythmias (P=.04). These were the only statistically significant associations. Of note, 24 patients (26%) who had an NCCP-GI diagnosis had a history of MI

DISCUSSION

Noncardiac chest pain is common and costly. Patients with NCCP are seen in primary care, in the ED, and by subspecialists. With the exception of costs, little is known about health care utilization after a diagnosis of NCCP.

The first aim of this study was to determine the frequency of GI consultation and testing. In this sample, 49% of patients were reevaluated in the ED, and 42% underwent repeated cardiology evaluations; only 15% had GI consultations after the initial diagnosis of NCCP.

CONCLUSION

The frequency of health care utilization in community residents with NCCP is high. Patients in this study received few GI consultations and underwent even fewer GI tests. Patients with NCCP seen in esophageal laboratories represent a very small fraction of people with NCCP in the community. Further study is needed to determine whether patients with NCCP would benefit from more frequent GI consultations and more diverse use of GI testing modalities.

Patients dismissed from the hospital with NCCP

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    Support was provided by TAP Pharmaceutical Products (now part of Takeda Pharmaceuticals North America).

    This study was presented in part at the American College of Gastroenterology Annual Scientific Meeting; October 24, 2006; Las Vegas, NV; and Digestive Disease Week; May 21, 2007; Washington, DC.

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