Causes of chest pain in primary care – a systematic review and meta-analysis

Abstract

AimTo investigate the frequencies of different and relevant underlying etiologies of chest pain in general practice.MethodsWe systematically searched PubMed and EMBASE. Two reviewers independently rated the eligibility of publications and assessed the risk of bias of included studies. We extracted data to calculate the relative frequencies of different underlying conditions and investigated the variation across studies using forest plots, I2, tau2, and prediction intervals. With respect to unexplained heterogeneity, we provided qualitative syntheses instead of pooled estimates.ResultsWe identified 11 eligible studies comprising about 6500 patients. The overall risk of bias was rated as low in 6 studies comprising about 3900 patients. The relative frequencies of different conditions as the underlying etiologies of chest pain reported by these studies ranged from 24.5 to 49.8% (chest wall syndrome), 13.8 to 16.1% (cardiovascular diseases), 6.6 to 11.2% (stable coronary heart disease), 1.5 to 3.6% (acute coronary syndrome/myocardial infarction), 10.3 to 18.2% (respiratory diseases), 9.5 to 18.2% (psychogenic etiologies), 5.6 to 9.7% (gastrointestinal disorders), and 6.0 to 7.1% (esophageal disorders).ConclusionThis information may be of practical value for general practitioners as it provides the pre-test probabilities for a range of underlying diseases and may be suitable to guide the diagnostic process.

Frequency of chest pain in primary care, diagnostic tests performed and final diagnoses

“…In literature, several studies have presented final diagnoses of chest pain in patients presenting in primary care 4. However, less serious final diagnoses fail to reflect potential doubts by GPs earlier in the diagnostic process.…”

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

“…Though the proportion of ED visits resulting in an ACS diagnosis has decreased by 45% over the past decade, chest pain is triaged as requiring urgent or emergent evaluation 2–3 times more frequently than other symptoms. 3 Many patients in ED 3 and primary care settings 2,4 have a negative cardiac workup, but continue to have symptoms.…”

Introductory Chapter: The Patient Presenting with Chest Pain

“…In the primary care setting on the contrary, less than 2% of patients will end up having ACS [10]. Up to one-third of the causes for chest pain in ambulatory visits are due to chest wall-related pain [11,12].…”