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Cited by 151Acute Myocardial Infarction ResearchCardiac Imaging and DiagnosticsCardiac Health and Mental Health

How effective are rapid access chest pain clinics? Prognosis of incident angina and non-cardiac chest pain in 8762 consecutive patients

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Sekhri, N, Feder, G S, Junghans, C, Hemingway, H, Timmis, A D·2007·Heart
DOI 10.1136/hrt.2006.090894PMC PMC1861500
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Abstract

OBJECTIVE: To determine whether rapid access chest pain clinics are clinically effective by comparison of coronary event rates in patients diagnosed with angina with rates in patients diagnosed with non-cardiac chest pain and the general population. DESIGN: Multicentre cohort study of consecutive patients with chest pain attending the rapid access chest pain clinics (RACPCs) of six hospitals in England. PARTICIPANTS: 8762 patients diagnosed with either non-cardiac chest pain (n = 6396) or incident angina without prior myocardial infarction (n = 2366) at first cardiological assessment, followed up for a median of 2.57 (interquartile range 1.96-4.15) years. MAIN OUTCOME MEASURES: Primary end point--death due to coronary heart disease (International Classification of Diseases (ICD)10 I20-I25) or acute coronary syndrome (non-fatal myocardial infarction (ICD10 I21-I23), hospital admission with unstable angina (I24.0, I24.8, I24.9)). Secondary end points--all-cause mortality (ICD I20), cardiovascular death (ICD10 I00-I99), or non-fatal myocardial infarction or non-fatal stroke (I60-I69). RESULTS: The cumulative probability of the primary end point in patients diagnosed with angina was 16.52% (95% confidence interval (CI) 14.88% to 18.32%) after 3 years compared with 2.73% (95% CI 2.29% to 3.25%) in patients with non-cardiac chest pain. Coronary standardised mortality ratios for men and women with angina aged <65 years were 3.52 (95% CI 1.98 to 5.07) and 4.39 (95% CI 1.14 to 7.64). Of the 599 patients who had the primary end point, 194 (32.4%) had been diagnosed with non-cardiac chest pain. These patients were younger, less likely to have typical symptoms, more likely to be south Asian and more likely to have a normal resting electrocardiogram than patients with angina who had the primary end point. CONCLUSION: RACPCs are successful in identifying patients with incident angina who are at high coronary risk, but there is a need to reduce misdiagnosis and improve outcomes in patients diagnosed with non-cardiac chest pain who accounted for nearly one third of cardiac events during follow-up.

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  • Patients with excessive health anxiety attend emergency departments frequently, but very few have any significant medical pathology.

    “patients with excessive health anxiety set a very low bar for such a call and also attend emergency departments frequently, but very few have any significant medical pathology.20,21”

    From Why health anxiety needs to be recognised in hospital practice (2020) · cites this paper as [20]

    The Conclusion (page not available) says that more than 70% of rapid-access chest pain clinic patients were diagnosed with non-cardiac chest pain. That provides limited support for a low rate of cardiac diagnoses in that clinic population, but the paper does not assess excessive health anxiety, frequent emergency-department attendance, or significant medical pathology more broadly. (LLM, conf=0.85)

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Authors
Sekhri, N., Feder, G. S., Junghans, C., Hemingway, H., & Timmis, A. D.
Affiliations
  • Newham University Hospital (GB)
  • Queen Mary University of London (GB)
  • University College London (GB)
Corresponding author
Timmis, A D
ORCID
Venue
Heart
Publisher
BMJ
Published
2006-06-21
Volume
93
Issue
4
Pages
458-463
ISSN
  • 1355-6037 (ISSN-L)
  • 1468-201X
DOI
10.1136/hrt.2006.090894
PMC
PMC1861500
OpenAlex
W2110148421
Cited by
151
References
32
Citations by year
2025: 2 · 2024: 2 · 2023: 6 · 2022: 6 · 2021: 3 · 2020: 11 · 2019: 12 · 2018: 10 · 2017: 7 · 2016: 7 · 2015: 11 · 2014: 8 · 2013: 5 · 2012: 15
FWCI
6.88
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Heart (publishedVersion, other-oa)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
rapid access chest pain clinic, non-cardiac chest pain, angina pectoris, coronary heart disease mortality, acute coronary syndrome, myocardial infarction, cardiovascular mortality, prognosis, South Asian patients, electrocardiogram, clinical effectiveness, chest pain clinic, unstable angina, all-cause mortality
MeSH terms
Angina Pectoris, Chest Pain, Coronary Disease, Diagnostic Errors, England, Female, Health Services Accessibility, Humans, Male, Middle Aged, Prognosis, Risk Factors, Sensitivity and Specificity, Cohort Studies, Survival Analysis, Pain Clinics

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