TITLE

How effective are rapid access chest pain clinics? Prognosis of incident angina and non-cardiac chest pain in 8762 consecutive patients

AUTHOR(S)
Sekhri, N.; Feder, G. S.; Junghans, C.; Hemingway, H.; Timmis, A. D.
PUB. DATE
April 2007
SOURCE
Heart;Apr2007, Vol. 93 Issue 4, p458
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To determine whether rapid access chest pain clinics are clinically effective by comparison of coronary event rates in patients diagnosed with angina with rates in patients diagnosed with non-cardiac chest pain and the general population. Design: Multicentre cohort study of consecutive patients with chest pain attending the rapid access chest pain clinics (RACPCs) of six hospitals in England. Participants: 8762 patients diagnosed with either non-cardiac chest pain (n = 6396) or incident angina without prior myocardial infarction (n = 2366) at first cardiological assessment, followed up for a median of 2.57 (interquartile range 1.96-4.15) years. Main outcome measures: Primary end point-death due to coronary heart disease (international Classification of Diseases (ICD)10 120-125) or acute coronary syndrome (non-fatal myocardial infarction (ICD10 121-123), hospital admission with unstable angina (124.0, 124.8, 124.9)). Secondary end points-all-cause mortality (lCD 120), cardiovascular death (ICD10 100-199), or non-fatal myocardial infarction or non- fatal stroke (160-169). Results: The cumulative probability of the primary end point in patients diagnosed with angina was 16.52% (95% confidence interval (CI) 14.88% to 18.32%) after 3 years compared with 2.73% (95% CI 2.29% to 3.25%) in patients with non-cardiac chest pain. Coronary standardised mortality ratios for men and women with angina aged <65 years were 3.52 (95% CI 1.98 to 5.07) and 4.39 (95% CI 1.14 to 7.64). Of the 599 patients who had the primary end point, 194 (32.4%) had been diagnosed with non-cardiac chest pain. These patients were younger, less likely to have typical symptoms, more likely to be south Asian and more likely to have a normal resting electrocardiogram than patients with angina who had the primary end point. Conclusion: RACPCs are successful in identifying patients with incident angina who are at high coronary risk, but there is a need to reduce misdiagnosis and improve outcomes in patients diagnosed with non-cardiac chest pain who accounted for nearly one third of cardiac events during follow-up.
ACCESSION #
25570508

 

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