Chest pain is a common reason for patients to seek help from their doctor. It may indicate heart (coronary) disease or be caused by a non-coronary problem like a musculoskeletal problem or anxiety. Many patients with chest pain will not be given a specific cause (diagnosis) for their chest pain by their GP and not have any further investigations. However, previous studies including our own have shown that patients with chest pain but not given a diagnosis have a higher risk of future heart disease than those without chest pain, and higher risk of future heart disease than patients diagnosed with non-coronary chest pain. In this study, patients recorded with chest pain but not given a diagnosis will be followed using their medical records for 10 years. We will determine: i) how easy it is to find out, at the time they first see their GP for chest pain, which patients are at most risk of future heart disease or stroke, ii) which patient characteristics predict future heart disease or stroke, and iii) how much targeting important risk factors like obesity, and how much use of early medication to prevent heart disease, may reduce the risk of future heart disease or stroke. Our study will allow GPs to determine more easily those at greatest risk, so they can be given appropriate treatment such as medication to prevent heart problems, and supported to reduce risk factors for heart disease.
Chest pain is a common symptom presented to general practice and may be caused by coronary heart disease or a non-coronary condition such as musculoskeletal disease or anxiety. Our previous study showed that many patients presenting to primary care with new chest pain will not receive a diagnosis and will not be investigated for coronary heart disease. However, studies including our own have also shown that patients with chest pain not attributed to a cause by the GP have an increased risk of future cardiovascular disease compared to those without chest pain and to those diagnosed with non-coronary chest pain. Investigation and instituting preventative measures in all undiagnosed patients with chest pain is not, however, practical. The aim of this study is to assess if it is possible to identify at time of presentation to primary care which patients with undiagnosed chest pain are at greatest risk of cardiovascular disease, and to model the effect of targeting key prognostic factors and preventative medication on incidence of cardiovascular disease in those at greatest risk. Patients presenting to primary care with new onset chest pain unattributed to a cause will be followed using their medical records for up to 10 years for incidence of cardiovascular disease, with a comparator group diagnosed with non-coronary chest pain. We will assess the performance of established cardiovascular risk algorithms in these groups, and use survival analysis to determine baseline factors most associated with onset of cardiovascular disease and to estimate the impact of reduction in levels of modifiable prognostic factors on incidence of cardiovascular disease. Routine assessment of these patients to identify those most at risk in order to offer preventative measures would be implementable in primary care and could contribute greatly to prevention of cardiovascular events.
Primary: Any cardiovascular
event;
Secondary: i) coronary event; ii) cerebrovascular event
Kelvin Jordan - Chief Investigator - Keele University
Kelvin Jordan - Corresponding Applicant - Keele University
Adam Timmis - Collaborator - Queen Mary University of London
Danielle van der Windt - Collaborator - Keele University
Harry Hemingway - Collaborator - University College London ( UCL )
James Bailey - Collaborator - Keele University
Lorna Clarson - Collaborator - Keele University
Mamas Mamas - Collaborator - Keele University
Milica Bucknall - Collaborator - Keele University
Richard Hayward - Collaborator - Keele University
Spiros Denaxas - Collaborator - University College London ( UCL )
Theocharis Kyriacou - Collaborator - Keele University
Trishna Rathod-Mistry - Collaborator - Keele University
Ying Chen - Collaborator - Keele University
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Townsend Score