TY - JOUR
T1 - Patients dismissed from the hospital with a diagnosis of noncardiac chest pain
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 - 2010/4
Y1 - 2010/4
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.
KW - CABG = coronary artery bypass graft
KW - CI = confidence interval
KW - ED = emergency department
KW - EGD = esophagogastroduodenoscopy
KW - GERD = gastroesophageal reflux disease
KW - GI = gastrointestinal
KW - MI = myocardial infarction
KW - NCCP = noncardiac chest pain
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U2 - 10.4065/mcp.2009.0428
DO - 10.4065/mcp.2009.0428
M3 - Article
C2 - 20194143
AN - SCOPUS:77950624508
SN - 0025-6196
VL - 85
SP - 323
EP - 330
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 4
ER -