Excess of mortality in patients with chest pain peaks in the first 3 days period after the incident and normalizes after 1 month.
BACKGROUND
patients presenting with chest pain have a 5% chance of experiencing a coronary event. These patients are at risk of mortality and should be recognized and referred to secondary care. Aim. To determine the relationship between referral type and mortality in patients with chest pain.


METHODS
the design of the study is an observational study. The setting of the study is a sentinel network of general practices in Belgium, covering 1.6% of the total population. The subjects are 1558 consecutive patients consulting with chest pain in 2003. Descriptive analyses report the standardized mortality ratios. We used the Belgian population of 1999 as the reference population and as the standard population.


RESULTS
the standardized mortality ratios of 3 days were 151.0 [95% confidence interval (CI): 82.3-250.3] for the urgent referred group, 45.5 (95% CI: 12.4-116.0) for non-urgent and 13.6 (95% CI: 1.7-49.4) for the non-referred group. The standardized ratios of 1 month were, respectively, 27.6 (95% CI: 18.0-40.4), 6.7 (95% CI: 2.5-14.6) and 4.7 (95% CI: 1.9-9.7). The standardized ratios of 2-12 months were normal for the urgent referral group (1.3; 95% CI: 0.7-2.2) and for the non-urgent referral group (1.0; 95% CI: 0.5-1.9) and even less in the non-referred group (0.4; 95% CI: 0.2-0.9).


CONCLUSIONS
mortality in the first 3 days and first month after consulting for chest pain is very high. There is a marked trend in mortality according to the referral type-urgently referred, non-urgently referred and not referred-suggesting risk stratification by the GP. After 1 month, mortality normalizes for all groups, suggesting that the surviving patients are well treated and the condition causing the chest pain no longer influences survival compared to the general population.
Bruyninckx
Rudi
R
Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium. rudi.bruyninckx@skynet.be
Van den Bruel
Ann
A
Buntinx
Frank
F
Van Casteren
Viviane
V
Aertgeerts
Bert
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality*; D003951:Diagnostic Errors; D004630:Emergencies; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors