ORIGINAL ARTICLEPatients Dismissed From the Hospital With a Diagnosis of Noncardiac Chest Pain: Cardiac Outcomes and Health Care Utilization
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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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Cited by (28)
Chest Pain: If It Is Not the Heart, What Is It?
2018, Nursing Clinics of North AmericaHeart-focused anxiety and health care seeking in patients with non-cardiac chest pain: A prospective study
2018, General Hospital PsychiatryCitation Excerpt :We found that HFA, the presence of a medical condition, the frequency of NCCP and its level of interference in daily functioning were all independently associated with further medical consultations in patients with NCCP. Our findings regarding the total number of medical consultations converge with previous ones [10,49,50]. Only 9 patients (2.1%) had seen a psychiatrist, even though 35% to 40% of ED patients with NCCP would present at least one psychiatric disorder [20,51].
Noncardiac chest pain after acute myocardial infarction: Frequency and association with health status outcomes
2017, American Heart JournalEmergency Department Cardiopulmonary Evaluation of Low-Risk Chest Pain Patients with Self-Reported Stress and Anxiety
2017, Journal of Emergency MedicineCitation Excerpt :Further, previous findings indicate that up to 55% of patients with non-cardiopulmonary chest pain may be suffering from anxiety or panic disorders, and these psychiatric disorders remain undiagnosed in almost 90% of cases (7–13). Costs associated with the evaluation of chest pain found not to be related to an emergent cardiopulmonary condition have been estimated to be between $315 million and $8 billion per year, usually with no definitive cause contributing to recurrent ED visits (14,15). We sought to measure the frequency of self-identified stress or anxiety among a large prospectively collected cohort of patients presenting to the ED with chest pain and compare their pretest probabilities, care processes, and outcomes.
Delays in the treatment of patients with acute coronary syndrome: Focus on pre-hospital delays and non-ST-elevated myocardial infarction
2016, International Journal of CardiologyCitation Excerpt :Even in patients admitted to the hospital with suspected ACS, up to 30% have a different discharge diagnosis [29]. NCCP can be of musculoskeletal, gastro-intestinal, psychological, or respiratory origin, [9,26,30,31] though the prevalence of these conditions is not well known [26]. Potentially life-threatening disorders as pulmonary embolism or thoracic aortic dissection have a low incidence in patients suspected of ACS [9].
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.