Chest pain and subsequent consultation for coronary heart disease: a prospective cohort study.
BACKGROUND
Chest pain may not be reported to general practice but could be an important first sign of coronary heart disease (CHD).


OBJECTIVE
To determine whether self-reported chest pain predicts future consultation for CHD in those with no history of consultation for CHD.


METHODS
Population-based study, with 7 year's follow up by GP record linkage.


METHODS
General practice in North Staffordshire.


METHODS
A survey, including the Rose angina questionnaire, was mailed to 4002 adults. Linked GP records used to identify responders with no record of CHD (G3 Read code or British National Formulary code for nitrate use) in the 32 months before the survey to form the sample for a 7-year prospective study. 'Survival' was compared in those with and without self-reported chest pain up to the earliest date of GP diagnosis of CHD, death, or end of the study period.


RESULTS
The survey response was 65% and 2348 participants gave permission to access their GP records. Of these, 2229 had no prior consultation for CHD. From the questionnaire, 558 reported chest pain of which 186 reported exertional pain and 103 met the criteria for angina. When followed prospectively, incidence of CHD consultations was higher in those with any chest pain definition, compared with no pain, and continued to be so for 7 years subsequently. Although these associations were strongly age related, self-reported symptoms were found to be an independent risk factor for future consultation for CHD.


CONCLUSIONS
This study highlighted that self-reported chest pain is a marker of future CHD. The usefulness of early identification of people with this symptom remains to be established.
Croft
Peter R
PR
Primary Care Musculoskeletal Research Centre, Keele University, Keele.
Thomas
Elaine
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D016021:Epidemiologic Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires