title: Unexplained acute chest pain in young adults: disease patterns and medication use 25 years later.
abstract: BACKGROUND
  Patients with unexplained chest pain are commonly revisiting an emergency department with various symptoms, but comprehensive long-term studies are lacking.
  
  
  METHODS
  A total of 150 young adults (aged 18-40 years) with unexplained chest pain who presented at an emergency unit for 16 weeks in mid-1980s were included in a prospective cohort study. An age- and sex-matched control group was randomly selected from the same area. Data were retrieved from registers that recorded death, income, education, country of birth, diagnoses, hospitalizations, outpatient visits, and medications dispensed.
  
  
  RESULTS
  Patients with unexplained acute chest pain had lower levels of education and income and were more often immigrants. Long-term mortality rates did not differ between cases (4%) and controls (5%) during 25 years of follow-up, nor were there differences in diagnosis of ischemic heart disease. Patients with unexplained acute chest pain had more outpatient visits (median, 5 versus 2; p < .0001) and had more often been hospitalized (61.6% ever versus 41.8%; p < .001) during the follow-up period. Several disorders were more common among patients 20 to 25 years later, including atrial fibrillation, esophageal/gastric disorders, chest pain, palpitations, abdominal discomfort, musculoskeletal symptoms, sleeping disturbance, and stress reactions (p values < .05). More patients had been given antihypertensives, anticoagulants, antidepressants, analgesics, and hypnotics/tranquilizers (p values < .05).
  
  
  CONCLUSIONS
  Young patients admitted to the emergency department with unexplained acute chest pain showed no increased risk of mortality or ischemic heart disease during 25 years of follow-up, but they had higher incidence of a wide range of disorders and used more medications. Early identification and preventive interventions may improve health outcomes in these patients.
authors.affiliation: From the Departments of Clinical Sciences (Roll, Rosenqvist) and Cardiology (Roll, Rosenqvist), Division of Cardiovascular Medicine, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden; Public Healthcare Services Committee (Sjöborg, Wettermark), Stockholm County Council, Stockholm, Sweden; and Centre for Pharmacoepidemiology and Clinical Pharmacology (Wettermark), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Roll
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.forename: Bengt
authors.initials: B
authors.lastname: Sjöborg
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
mesh_terms: D059787:Acute Pain / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002637:Chest Pain / Q000453:epidemiology* / Q000401:mortality; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult