title: Chest pain in general practice: incidence, comorbidity and mortality.
abstract: BACKGROUND
  Chest pain is a common symptom that presents the primary care physician with a complex diagnostic and therapeutic challenge.
  
  
  OBJECTIVE
  To evaluate the natural history and management of patients diagnosed with chest pain of unspecified type or origin in primary care.
  
  
  METHODS
  Population-based case-control study.
  
  
  METHODS
  The study included 13,740 patients with a first diagnosis of unspecified chest pain and 20,000 age- and sex-matched controls identified from the UK General Practice Research Database. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression. Risk estimates were adjusted for age, sex and number of physician visits.
  
  
  RESULTS
  The incidence of a new diagnosis of chest pain was 15.5 per 1000 person-years and increased with age, particularly in men. The risk of a chest pain diagnosis was greatest in patients with prior diagnoses of coronary heart disease (OR: 7.1; 95% CI: 6.1-8.2) and gastroesophageal reflux disease (OR: 2.0; 95% CI: 1.7-2.3). In the year after diagnosis, chest pain patients were more likely than controls to be newly diagnosed with coronary heart disease (OR: 14.9; 95% CI: 12.7-17.4) and heart failure (OR: 4.7; 95% CI: 3.6-6.1). A new diagnosis of chest pain was associated with an increased risk of death in the following year (RR: 2.3; 95% CI: 1.9-2.8).
  
  
  CONCLUSIONS
  Some causes of chest pain are underdiagnosed in primary care. This is of particular consequence for the minority of chest pain patients with cardiac disease.
authors.affiliation: Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain. aruigomez@ceife.es
authors.forename: Ana
authors.initials: A
authors.lastname: Ruigómez
authors.forename: Luis Alberto García
authors.initials: LA
authors.lastname: Rodríguez
authors.forename: Mari-Ann
authors.initials: MA
authors.lastname: Wallander
authors.forename: Saga
authors.initials: S
authors.lastname: Johansson
authors.forename: Roger
authors.initials: R
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D019992:Databases as Topic; D005194:Family Practice; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology