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Health care delivery, economics and global health care
Original research article
Non-cardiac chest pain: prognosis and secondary healthcare utilisation
  1. Karen Anne Mol1,
  2. Agnieszka Smoczynska2,
  3. Braim Mohammed Rahel2,
  4. Joan Gerard Meeder2,
  5. Loes Janssen3,
  6. Pieter A Doevendans1 and
  7. Maarten-Jan Cramer1
  1. 1 Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
  2. 2 Department of Cardiology, VieCuri Medical Center, Venlo, The Netherlands
  3. 3 Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
  1. Correspondence to Dr Karen Anne Mol; k.a.mol{at}umcutrecht.nl

Abstract

Objective Presentations of non-cardiac chest pain (NCCP) to the emergency department (ED) are increasing. More knowledge of prognosis and healthcare utilisation of patients with NCCP is necessary to optimise their management.

Methods This study is a prospective, observational, prevalence-based cohort study conducted from September 2015 to February 2016 with 1-year follow-up including all patients 18 years and older referred to the ED with chest pain. Discharge diagnoses, mortality, major adverse cardiac events (MACE), re-presentations to the ED, hospitalisations, cardiac interventions and outpatient monitoring were assessed.

Results More than 60% of the 1239 patients presenting with chest pain were discharged with NCCP. The all-cause 1-year mortality rate of patients with NCCP was 2.3% compared with 7.2% in patients with cardiac chest pain (CCP) (p<0.001) and the occurrence of MACE was 5.1% vs 8.3%, respectively (p=0.026). Previous history of coronary artery disease (CAD) in patients with NCCP was identified as a predictive factor for MACE (OR 4.30 (95% CI 1.24 to 14.89), p=0.021). Patients with NCCP had more non-invasive interventions than patients with CCP (proportion of 0.225 vs 0.165 per patient, p<0.001) and 13.7% of patients with NCCP re-presented at the ED within 1  year.

Conclusion The majority of patients referred to the ED with chest pain are discharged with NCCP. The prognosis of patients with NCCP is better than patients with CCP; however, they are at risk for MACE due to a history of CAD. Patients with NCCP moreover use a substantial amount of medical resources, stressing the importance of good triage to minimise unnecessary healthcare utilisation while still preventing MACE.

  • Acute coronary syndrome
  • health care delivery
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2018-000859

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    Footnotes

    • KAM and AS contributed equally.

    • Contributors KAM, AS: planning, conduct and report of the work, responsible for the overall content. BMR: planning and review of the work JGM: planning an review of the work. LJ: statistical support and review of the work. PAD: review of the work. MJMC: planning and review of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval METC UMC Utrecht.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.