Patients dismissed from the hospital with a diagnosis of noncardiac chest pain

Cardiac outcomes and health care utilization

Michael D. Leise, G. Richard Locke, Ross A. Dierkhising, Alan R. Zinsmeister, Guy S. Reeder, Nicholas J. Talley

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)323-330
Number of pages8
JournalMayo Clinic Proceedings
Volume85
Issue number4
DOIs
StatePublished - 2010

Fingerprint

Patient Acceptance of Health Care
Chest Pain
Hospital Emergency Service
Cardiology
Referral and Consultation
Digestive System Endoscopy
Manometry
Risk Management
Gastroenterology
Patient Care
Epidemiology

Keywords

  • CABG = coronary artery bypass graft
  • CI = confidence interval
  • ED = emergency department
  • EGD = esophagogastroduodenoscopy
  • GERD = gastroesophageal reflux disease
  • GI = gastrointestinal
  • MI = myocardial infarction
  • NCCP = noncardiac chest pain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Leise, M. D., Locke, G. R., Dierkhising, R. A., Zinsmeister, A. R., Reeder, G. S., & Talley, N. J. (2010). Patients dismissed from the hospital with a diagnosis of noncardiac chest pain: Cardiac outcomes and health care utilization. Mayo Clinic Proceedings, 85(4), 323-330. https://doi.org/10.4065/mcp.2009.0428

Patients dismissed from the hospital with a diagnosis of noncardiac chest pain : Cardiac outcomes and health care utilization. / Leise, Michael D.; Locke, G. Richard; Dierkhising, Ross A.; Zinsmeister, Alan R.; Reeder, Guy S.; Talley, Nicholas J.

In: Mayo Clinic Proceedings, Vol. 85, No. 4, 2010, p. 323-330.

Research output: Contribution to journalArticle

Leise, Michael D. ; Locke, G. Richard ; Dierkhising, Ross A. ; Zinsmeister, Alan R. ; Reeder, Guy S. ; Talley, Nicholas J. / Patients dismissed from the hospital with a diagnosis of noncardiac chest pain : Cardiac outcomes and health care utilization. In: Mayo Clinic Proceedings. 2010 ; Vol. 85, No. 4. pp. 323-330.
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T2 - Cardiac outcomes and health care utilization

AU - Leise, Michael D.

AU - Locke, G. Richard

AU - Dierkhising, Ross A.

AU - Zinsmeister, Alan R.

AU - Reeder, Guy S.

AU - Talley, Nicholas J.

PY - 2010

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N2 - 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.

AB - 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.

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KW - CI = confidence interval

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KW - EGD = esophagogastroduodenoscopy

KW - GERD = gastroesophageal reflux disease

KW - GI = gastrointestinal

KW - MI = myocardial infarction

KW - NCCP = noncardiac chest pain

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