Hospitalised patients with unexplained chest pain: incidence and prognosis

Egeland, Grace M.; Akerkar, Rupali; Kvåle, Rune; Sulo, Gerhard; Tell, Grethe S.; Bakken, Inger Johanne; Ebbing, Marta

doi:10.1111/joim.12948

Cited by 7 publications

(9 citation statements)

References 21 publications

(21 reference statements)

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“…In contrast to the mortality rate of IPF patients which increased with age, the SMR of IPF patients decreased with age. Similar trends have been observed in studies investigating other diseases 22 , 23 . Although the absolute mortality rate was higher in older patients, the impact of IPF on mortality was higher in younger patients because the expected mortality of the general population at a younger age is very low.…”

Section: Discussionsupporting

confidence: 89%

All-cause mortality of patients with idiopathic pulmonary fibrosis: a nationwide population-based cohort study in Korea

Choi

Han

et al. 2021

Sci Rep

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Most epidemiologic studies of patients with idiopathic pulmonary fibrosis (IPF) have been conducted in North America and Europe. Moreover, there are limited data concerning the cause of death and cause-specific mortality rate of IPF patients in population-based studies. We analyzed information from the Korean National Health Insurance Service database from 2006 to 2016. Patients with a diagnosis code of IPF were extracted from the database and we included those who satisfied the narrow definition of IPF diagnosis. Age- and sex-matched controls were randomly selected at a case-to-control rate of 1:3. We included 42,777 patients newly diagnosed with IPF during the study period. Their mean age was 64.6 years, and 65.4% were male. The age-standardized mortality rates were 85.66 (95% confidence interval [CI] 84.45–86.89) per 1000 person-years. The survival rates of IPF patients 1, 2, 3, 5, and 10 years after IPF diagnosis were 84.5%, 77.4%, 71.9%, 62.9%, and 48.4%, respectively. The standardized mortality ratio of IPF patients compared to that of the normal population was 4.66. The leading cause of death in IPF patients was respiratory causes, followed by cancer. Patients with IPF in Korea showed significantly higher mortality compared to the general population.

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Section: Discussionsupporting

confidence: 89%

All-cause mortality of patients with idiopathic pulmonary fibrosis: a nationwide population-based cohort study in Korea

Choi

Han

et al. 2021

Sci Rep

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“… 28 , 29 Our study indicates risk of cardiovascular disease is higher in males, which has also been shown in patients discharged from hospital with unexplained chest pain. 30 Despite indications in our study from our full model (Model 5) that certain comorbidities (type 2 diabetes, atrial fibrillation, hypertension, and respiratory conditions) confer higher risk in females than males, and being obese a lower risk, the full prediction model including interaction terms with gender did not greatly improve the model compared to models without interaction, and gender-specific models also did not improve performance. Higher risk related to some comorbidity for females seen in the unattributed chest pain population is also generally evident for the general population.…”

Section: Discussioncontrasting

confidence: 55%

Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study

Jordan

Rathod‐Mistry

Windt

et al. 2023

European Journal of Preventive Cardiology

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Background Most adults presenting in primary care with chest pain symptoms will not receive a diagnosis (“unattributed” chest pain) but are at increased risk of cardiovascular events. Aim To assess within patients with unattributed chest pain, risk factors for cardiovascular events and whether those at greatest risk of cardiovascular disease can be ascertained by an existing general population risk prediction model or by development of a new model. Methods The study used UK primary care electronic health records from the Clinical Practice Research Datalink (CPRD) linked to admitted hospitalisations. Study population was patients aged 18 plus with recorded unattributed chest pain 2002-2018. Cardiovascular risk prediction models were developed with external validation and comparison of performance to QRISK3, a general population risk prediction model. Results There were 374,917 patients with unattributed chest pain in the development dataset. Strongest risk factors for cardiovascular disease included diabetes, atrial fibrillation, and hypertension. Risk was increased in males, patients of Asian ethnicity, those in more deprived areas, obese patients, and smokers. The final developed model had good predictive performance (external validation c-statistic 0.81, calibration slope 1.02). A model using a subset of key risk factors for cardiovascular disease gave nearly identical performance. QRISK3 underestimated cardiovascular risk. Conclusion Patients presenting with unattributed chest pain are at increased risk of cardiovascular events. It is feasible to accurately estimate individual risk using routinely recorded information in the primary care record, focusing on a small number of risk factors. Patients at highest risk could be targeted for preventative measures.

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“…One-year cycle length was chosen, and a half-cycle correction was applied to account for events occurring on average halfway through cycles. Living with CVD was assumed to have a hazard ratio of 1.6 compared to living without, based on two Norwegian analyses [ 33 , 34 ]. Details on other inputs are included in the Appendix .…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting

Johannessen

Halvorsen

Atar

et al. 2022

BMC Health Serv Res

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Aims Hospital admissions of patients with chest pain considered as low risk for acute coronary syndrome contribute to increased costs and crowding in the emergency departments. This study aims to estimate the cost-effectiveness of assessing these patients in a primary care emergency setting, using the European Society of Cardiology (ESC) 0/1-h algorithm for high-sensitivity cardiac troponin T, compared to routine hospital management. Methods A cost-effectiveness analysis was conducted. For the primary care estimates, costs and health care expenditure from the observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study were compared with anonymous extracted administrative data on low-risk patients at a large general hospital in Norway. Patients discharged home after the hs-cTnT assessment were defined as low risk in the primary care cohort. In the hospital setting, the low-risk group comprised patients discharged with a non-specific chest pain diagnosis (ICD-10 codes R07.4 and Z03.5). Loss of health related to a potential increase in acute myocardial infarctions the following 30-days was estimated. The primary outcome measure was the costs per quality-adjusted life year (QALY) of applying the ESC 0/1-h algorithm in primary care. The secondary outcomes were health care costs and length of stay in the two settings. Results Differences in costs comprise personnel and laboratory costs of applying the algorithm at primary care level (€192) and expenses related to ambulance transports and complete hospital costs for low-risk patients admitted to hospital (€1986). Additional diagnostic procedures were performed in 31.9% (181/567) of the low-risk hospital cohort. The estimated reduction in health care cost when using the 0/1-h algorithm outside of hospital was €1794 per low-risk patient, with a mean decrease in length of stay of 18.9 h. These numbers result in an average per-person QALY gain of 0.0005. Increased QALY and decreased costs indicate that the primary care approach is clearly cost-effective. Conclusion Using the ESC 0/1-h algorithm in low-risk patients in emergency primary care appears to be cost-effective compared to standard hospital management, with an extensive reduction in costs and length of stay per patient.

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Hospitalised patients with unexplained chest pain: incidence and prognosis

Cited by 7 publications

References 21 publications

All-cause mortality of patients with idiopathic pulmonary fibrosis: a nationwide population-based cohort study in Korea

All-cause mortality of patients with idiopathic pulmonary fibrosis: a nationwide population-based cohort study in Korea

Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study

Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting

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