Musculoskeletal pain and its impact on prognosis following acute coronary syndrome or stroke: A linked electronic health record cohort study

Abstract

ObjectiveMusculoskeletal painful conditions are a risk factor for cardiovascular disease (CVD), but less is known about whether musculoskeletal pain also worsens prognosis from CVD. The objective was to determine whether patients with musculoskeletal pain have poorer prognosis following acute coronary syndrome (ACS) or stroke.MethodsThe study utilised UK electronic primary care records (CPRD Aurum) with linkage to hospital and mortality records. Patients aged ≥45 years admitted to hospital with incident ACS/stroke were categorised by healthcare use for musculoskeletal pain (inflammatory conditions, osteoarthritis [OA], and regional pain) based on primary care consultations in the prior 24 months. Outcomes included mortality, length of stay, readmission and management of index condition (ACS/stroke).ResultsThere were 171,670 patients with incident ACS and 138,512 with stroke; 30% consulted for musculoskeletal pain prior to ACS/stroke and these patients had more comorbidity than those without musculoskeletal pain. Rates of mortality and readmission, and length of stay were higher in those with musculoskeletal pain, particularly OA and inflammatory conditions, in ACS. Readmission was also higher for patients with musculoskeletal pain in stroke. However, increased risks associated with musculoskeletal pain did not remain after adjustment for age and polypharmacy. Inflammatory conditions were associated with increased likelihood of prescriptions for dual anti‐platelets (ACS only) and anti‐coagulants.ConclusionsPatients with musculoskeletal pain have higher rates of poor outcome from ACS which relates to being older but also increased polypharmacy. The high rates of comorbidity including polypharmacy highlight the complexity of patients with musculoskeletal pain who have new onset ACS/stroke.

Pre-existing musculoskeletal pain and its association with mortality in newly diagnosed co-morbid conditions: an electronic health record cohort study

“…This is explained, in part, by being older, but in addition the observed associations seemed also to be explained by increased polypharmacy in patients with musculoskeletal pain. This is consistent with our previous study looking at short-term (30-day) outcomes in patients with a new ACS or stroke [ 32 ]. In the present study, we found that patients with musculoskeletal pain were being prescribed an average of 13–19 different medicines over 2 years.…”

“…Derivation of code lists was based on those previously developed through a rigorous consensus approach in research studies by health-care practitioners, epidemiologists and statisticians with expertise in electronic health record research at Keele University [ 11 , 23 , 24 ] and code lists based on those from external studies using electronic health records. The code lists used for each index condition can be found at https://eprints.keele.ac.uk/id/eprint/11580/ [ 25 ]. The date of first diagnosis of the index condition was defined as the index date for that patient.…”