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Demirçelik Y, Üzüm Ö, Eliaçik K, Kanik A, Bolat N, Elmali F, Demircan T, Güven B, Gündeş B, Helvaci M. Bodily sensations and quality of life in adolescents with non-cardiac chest pain: a comparative study for the undetermined part of a frequent health problem. Minerva Pediatr (Torino) 2024; 76:299-307. [PMID: 38842377 DOI: 10.23736/s2724-5276.21.06045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Chest pain in adolescents represents a considerable burden for health services and is rarely associated with cardiac disease. Since chest pain could be related to psychosocial factors there is a need for exploring the relationships among stressful situations, drug consumption, suicidal behaviors, accompanying bodily symptoms and health-related quality of life in adolescents with non-cardiac chest pain. METHODS In this study, we assessed these determinants in 108 adolescents with non-cardiac chest pain (NCCP) and a control group of 77 patients using a structured interview applied to the patients presented to the cardiology outpatient clinics of Tepecik Training and Research Hospital, İzmir, Türkiye, between 30 October 2018 and 30 June 2019. After the interview, the adolescents were given a self-administered pediatric quality of life inventory and the body sensations questionnaire for assessing aspects of fear. RESULTS Adolescents with NCCP expressed more panic associated bodily symptoms and reported worse subjective physical, academic, and emotional functioning in addition to more suicidal ideation. CONCLUSIONS NCCP could be accepted as a warning sign of an underlying psychosocial problem and requires a more interdisciplinary collaborative care by pediatricians, psychologists, and psychiatrists.
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Affiliation(s)
- Yavuz Demirçelik
- Department of Pediatrics, İzmir Tepecik Teaching and Research Hospital, İzmir, Türkiye -
| | - Özlem Üzüm
- Department of Pediatrics, İzmir Tepecik Teaching and Research Hospital, İzmir, Türkiye
| | - Kayı Eliaçik
- Division of Adolescent Medicine, İzmir Tepecik Teaching and Research Hospital, İzmir, Türkiye
| | - Ali Kanik
- Department of Pediatrics, İzmir Katip Çelebi University School of Medicine, İzmir, Türkiye
| | - Nurullah Bolat
- Department of Child and Adolescent Psychiatry, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Türkiye
| | - Ferhan Elmali
- Department of Biostatistics, İzmir Katip Çelebi University School of Medicine, İzmir, Türkiye
| | - Tülay Demircan
- Department of Pediatric Cardiology, İzmir Tepecik Teaching and Research Hospital, İzmir, Türkiye
| | - Barış Güven
- Department of Pediatric Cardiology, İzmir Tepecik Teaching and Research Hospital, İzmir, Türkiye
| | - Berna Gündeş
- Department of Family Medicine, İzmir Tepecik Teaching and Research Hospital, İzmir, Türkiye
| | - Mehmet Helvaci
- Department of Pediatrics, İzmir Tepecik Teaching and Research Hospital, İzmir, Türkiye
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Yu C, Brazete S, Gullick J, Garcia MT, Brieger D, Kritharides L, Naoum C, Ng ACC, Lowe HC. Long-Term Outcomes Following Rapid Access Chest Pain Clinic Assessment: First Australian Data. Heart Lung Circ 2021; 30:1309-1313. [PMID: 33814303 DOI: 10.1016/j.hlc.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/21/2020] [Accepted: 02/07/2021] [Indexed: 11/15/2022]
Abstract
Australian guidelines recommend prompt evaluation of patients presenting to emergency departments with chest pain, found to be low risk for acute coronary syndromes, and cardiologist-led Rapid Access Chest Pain Clinics (RACPC) have been proposed as a model to provide such care. Initial Australian experience of RACPCs suggests excellent short-term outcomes, and that they are cost-beneficial, though little data exists examining longer-term outcomes. The present study therefore examines such longer-term outcomes to beyond 5 years following presentation to an RACPC in an Australian tertiary metropolitan centre.
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Affiliation(s)
- Chris Yu
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Susana Brazete
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Janice Gullick
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - M Tessa Garcia
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - David Brieger
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Leonard Kritharides
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Chris Naoum
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Austin C C Ng
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Harry C Lowe
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia.
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Eliacik K, Bolat N, Kanik A, Malas N, Demircan T, Hortu H, Özyurt G, Orbatu D, Alaygut D, Guven B. Adolescents with unexplained chest pain reported depression and impaired emotional and social functioning. Acta Paediatr 2020; 109:1642-1648. [PMID: 31860731 DOI: 10.1111/apa.15144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/24/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
AIM Chest pain is common in adolescence, but there are no established criteria for managing this problem, which is rarely associated with cardiac disease. This study addressed the gaps in the literature by evaluating psychosocial factors that could be associated with medically unexplained chest pain. METHODS We consecutively selected 100 patients (68% girls) aged 13-18 who were diagnosed with unexplained chest pain when they presented to the cardiology outpatient clinics of Tepecik Research Hospital, İzmir, Turkey, between 30 September 2015 and 30 June 2018. The controls were 76 age- and sex-matched adolescents (69% girls) aged 13-18 who were undergoing routine cardiology assessments before joining sports clubs. We assessed their health-related quality of life and any depression and physical symptoms. RESULTS Regression analysis showed some adolescents were a number of times more likely to report chest pain. These included those who reported boredom (4.1 times), felt stressed or anxious (2.2) and those who experienced sleep disturbance (2.6), co-morbid headaches (2.0), back pain (3.1) and impaired social functioning (1.2). CONCLUSION The results indicated a significant association between unexplained chest pain and physical symptoms, depression and impaired emotional and social functioning. These factors warrant further evaluation.
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Affiliation(s)
- Kayi Eliacik
- Division of Adolescent Medicine Tepecik Training and Research Hospital İzmir Turkey
| | - Nurullah Bolat
- Department of Child and Adolescent Psychiatry Onsekiz Mart University School of Medicine Çanakkale Turkey
| | - Ali Kanik
- Department of Paediatrics Katip Çelebi University School of Medicine İzmir Turkey
| | - Nasuh Malas
- Department of Psychiatry and Department of Paediatrics University of Michigan Medical School Ann Arbor MI USA
| | - Tülay Demircan
- Department of Paediatric Cardiology Tepecik Training and Research Hospital İzmir Turkey
| | - Hacer Hortu
- Division of Adolescent Medicine Tepecik Training and Research Hospital İzmir Turkey
| | - Gonca Özyurt
- Department of Child and Adolescent Psychiatry Katip Çelebi University School of Medicine İzmir Turkey
| | - Dilek Orbatu
- Department of Paediatrics Tepecik Training and Research Hospital İzmir Turkey
| | - Demet Alaygut
- Department of Paediatrics Tepecik Training and Research Hospital İzmir Turkey
| | - Baris Guven
- Department of Paediatric Cardiology Tepecik Training and Research Hospital İzmir Turkey
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Kite TA, Gaunt H, Banning AS, Roberts E, Kovac J, Hudson I, Gershlick AH. Clinical outcomes of patients discharged from the Rapid Access Chest Pain Clinic with non-anginal chest pain: A retrospective cohort study. Int J Cardiol 2020; 302:1-4. [PMID: 31864788 DOI: 10.1016/j.ijcard.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/19/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Rapid Access Chest Pain Clinic (RACPC) has become an important means of assessing patients who present with ischaemic or ischaemia-like symptoms of recent onset. Observations have shown that up to 70% are discharged with a diagnosis of non-anginal chest pain (NACP) and accordingly "reassured". This study aims to describe the actual clinical outcomes of this cohort of patients discharged from the RACPC. METHODS We undertook a single centre retrospective cohort study at a tertiary cardiac hospital. The outcomes of unselected patients diagnosed with NACP and discharged from the RACPC between April 2010 and March 2013 at University Hospitals of Leicester (UHL) were recorded. Re-referrals to cardiology outpatient clinic and emergency hospital admissions for cardiovascular disease within 6 months, and the mortality rate at 12 months, were determined. RESULTS 7066 patients were seen in the UHL RACPC during the 36-month period. 3253 (46.0%) were diagnosed with NACP and discharged. 7 (0.2%) were diagnosed with coronary artery disease (CAD) and 8 (0.25%) cases of acute coronary syndrome (ACS) identified during the review period. 11 (0.3%) patients died within 12 months of discharge from RACPC. No deaths were attributable to CAD. CONCLUSIONS Comprehensive assessment using risk-stratification criteria in a nurse practitioner-led RACPC can accurately identify patients who are at low-risk for subsequent CAD. Despite contemporary National Institute for Health and Care Excellence (NICE) guidelines that shift focus away from a clinical judgement based approach, this strategy appears to robustly predict favourable outcomes in patients diagnosed with NACP.
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Affiliation(s)
- T A Kite
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Centre, University Hospitals of Leicester Glenfield Hospital, Leicester LE3 9QP, United Kingdom; Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - H Gaunt
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Centre, University Hospitals of Leicester Glenfield Hospital, Leicester LE3 9QP, United Kingdom; Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A S Banning
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Centre, University Hospitals of Leicester Glenfield Hospital, Leicester LE3 9QP, United Kingdom; Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - E Roberts
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Centre, University Hospitals of Leicester Glenfield Hospital, Leicester LE3 9QP, United Kingdom; Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Kovac
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Centre, University Hospitals of Leicester Glenfield Hospital, Leicester LE3 9QP, United Kingdom; Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - I Hudson
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Centre, University Hospitals of Leicester Glenfield Hospital, Leicester LE3 9QP, United Kingdom; Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A H Gershlick
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Centre, University Hospitals of Leicester Glenfield Hospital, Leicester LE3 9QP, United Kingdom; Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
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First time referral reasons, diagnoses and 10-year follow-up of patients seen at a Dutch fast lane outpatient cardiology clinic. Neth Heart J 2019; 27:354-361. [PMID: 30953280 PMCID: PMC6639834 DOI: 10.1007/s12471-019-1266-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose To describe reasons for referral, diagnostic procedures, diagnoses and long-term follow-up of first-time referred patients to a fast lane outpatient cardiology clinic (FLOCC). Methods A descriptive report of results obtained in a newly organised outpatient clinic. Data up to final diagnosis were recorded from electronic medical records. Follow-up data were obtained from electronic medical records, contacting patients and/or their general practitioners. Results During the first 3 months of 2007, 419 patients were seen at the FLOCC. Of these patients, 360 were referred by general practitioners, 55 by other specialists and four were self-referrals. The largest referral groups were: chest complaints (44%), palpitations (19%) and dyspnoea (12%). In 65% of the 419 patients, cardiovascular disease was ruled out and they were discharged. Of these, 41% of the diagnoses were made on the same day, with a further 44% after additional investigations, mostly Holter registration. During 10 years of follow-up, 49 patients died: 17 of cardiac, 29 of non-cardiac, mainly cancer, and three of unknown causes. Of the initially discharged patients, 35% were referred again after an average of 4 years (1,443 days), with 47% reporting similar complaints. Conclusion Of the patients referred to our FLOCC, most had chest pain. In one-third of all patients, cardiac disease was ruled out on the same day. Of all the patients discharged, 85% were diagnosed after basic investigations that could be ordered by a general practitioner. Holter registration was the most frequently requested additional investigation. These results support the development of less expensive, easily accessible extramural cardiology clinics.
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Anxiety, depression, suicidal ideation, and stressful life events in non-cardiac adolescent chest pain: a comparative study about the hidden part of the iceberg. Cardiol Young 2017; 27:1098-1103. [PMID: 27830640 DOI: 10.1017/s1047951116002109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chest pain in adolescents is rarely associated with cardiac disease. Adolescents with medically unexplained chest pain usually have high levels of anxiety and depression. Psychological stress may trigger non-cardiac chest pain. This study evaluated risk factors that particularly characterise adolescence, such as major stressful events, in a clinical population. The present study was conducted on 100 adolescents with non-cardiac chest pain and 76 control subjects. Stressful life events were assessed by interviewing patients using a 36-item checklist, along with the Children's Depression Inventory and Spielberger's State-Trait Anxiety Inventory for children, in both groups. Certain stressful life events, suicidal thoughts, depression, and anxiety were more commonly observed in adolescents with non-cardiac chest pain compared with the control group. Moreover, binary logistic regression analysis showed that trouble with bullies, school-related problems, and depression may trigger non-cardiac chest pain in adolescents. Non-cardiac chest pain on the surface may point to the underlying psychosocial health problems such as depression, suicidal ideas, or important life events such as academic difficulties or trouble with bullies. The need for a psychosocial evaluation that includes assessment of negative life events and a better management have been discussed in light of the results.
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Nilsson S, Järemo P. Non-coronary chest pain does not affect long-term mortality: a prospective, observational study using a matched population control. BMC FAMILY PRACTICE 2016; 17:159. [PMID: 27852221 PMCID: PMC5112656 DOI: 10.1186/s12875-016-0559-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 11/04/2016] [Indexed: 11/10/2022]
Abstract
Background Chest pain assumed to be of non-coronary origin (NCCP) may be linked to enhanced mortality due to coronary heart disease (CHD). The aim of this study was to follow NCCP patients, as defined in primary care, with respect to mortality and long-term morbidity of CHD. We further examined if NCCP associates with risk factors for CHD. Methods Patients consulting general practitioners (GPs) in 1998–2000 in three primary care centers in the southeast Sweden for chest pain regarded as NCCP were compared with controls matched for age, gender and residential area. Causes of death were gathered from registry data and death certificates. In 2005 a postal questionnaire was distributed to the survivors to collect demographic and clinical data. If participants had CHD diagnosed by a physician prior to inclusion they were excluded. Results Patients with NCCP (n = 382) and population controls (n = 746) did not differ with respect to mortality and incidence of CHD. The NCCP group reported more ongoing chest pain (OR 3.34 95 % CI 2.41–4.62), they more often had elevated blood pressure (OR 1.86 95 % CI 1.32–2.60), consumed more β-blockers (p < 0.001), aspirin (p = 0.013), thiazides (p = 0.004) and long-acting nitrates (p = 0.002). They further had more remedies for acid-related disorders (p = 0.014) and obstructive pulmonary disease (p < 0.001). Conclusions The study suggests that individuals with chest pain judged by GPs to be NCCP do not develop CHD more frequently than population controls. It is evident that NCCP often lasts for many years and that the condition associates with hypertension.
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Affiliation(s)
- Staffan Nilsson
- Primary Health Care and Department of Medicine and Health Sciences, Linköping University, Norrköping, Sweden. .,Vikbolandet Health Care Centre, Bygdevägen 13, Vikbolandet, SE-610 24, Sweden.
| | - Petter Järemo
- Department of Internal Medicine, The Vrinnevi Hospital, Norrköping, Sweden
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Ayerbe L, González E, Gallo V, Coleman CL, Wragg A, Robson J. Clinical assessment of patients with chest pain; a systematic review of predictive tools. BMC Cardiovasc Disord 2016; 16:18. [PMID: 26790953 PMCID: PMC4721048 DOI: 10.1186/s12872-016-0196-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/15/2016] [Indexed: 01/10/2023] Open
Abstract
Background The clinical assessment of patients with chest pain of recent onset remains difficult. This study presents a critical review of clinical predictive tools for the assessment of patients with chest pain. Methods Systematic review of observational studies and estimation of probabilities of coronary artery disease (CAD) in patients with chest pain. Searches were conducted in PubMed, Embase, Scopus, and Web of Science to identify studies reporting tools, with at least three variables from clinical history, physical examination or ECG, produced with multivariate analysis, to estimate probabilities of CAD in patients with chest pain of recent onset, published from inception of the database to the 31st July 2015. The references of previous relevant reviews were hand searched. The methodological quality was assessed with standard criteria. Since the incidence of CAD has changed in the past few decades, the date of publication was acknowledged to be relevant in order to use the tool in clinical practice, and more recent papers were considered more relevant. Probabilities of CAD according to the studies of highest quality were estimated and the evidence provided was graded. Results Twelve papers were included out of the 19126 references initially identified. The methodological quality of all of them was high. The clinical characteristics of the chest pain, age, past medical history of cardiovascular disease, gender, and abnormalities in the ECG were the predictors of CAD most commonly reported across the studies. The most recent papers, with highest methodological quality, and most practical for use in clinical settings, reported prediction or exclusion of CAD with area under the curve 0.90 in Primary Care, 0.91 in Emergency department, and 0.79 in Cardiology. These papers provide evidence of high level (1B) and the recommendation to use their results in the management of patients with chest pain is strong (A). Conclusions The risk of CAD can be estimated on clinical grounds in patients with chest pain in different clinical settings with high accuracy. The estimation of probabilities of CAD presented in these studies could be used for a better management of patients with chest pain and also in the development of future predictive tools. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0196-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luis Ayerbe
- Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
| | - Esteban González
- Family Medicine Unit, Department of Medicine, Autónoma University of Madrid, Madrid, Spain
| | - Valentina Gallo
- Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Claire L Coleman
- Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Andrew Wragg
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
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Abstract
BACKGROUND Patients with unexplained chest pain are commonly revisiting an emergency department with various symptoms, but comprehensive long-term studies are lacking. METHODS A total of 150 young adults (aged 18-40 years) with unexplained chest pain who presented at an emergency unit for 16 weeks in mid-1980s were included in a prospective cohort study. An age- and sex-matched control group was randomly selected from the same area. Data were retrieved from registers that recorded death, income, education, country of birth, diagnoses, hospitalizations, outpatient visits, and medications dispensed. RESULTS Patients with unexplained acute chest pain had lower levels of education and income and were more often immigrants. Long-term mortality rates did not differ between cases (4%) and controls (5%) during 25 years of follow-up, nor were there differences in diagnosis of ischemic heart disease. Patients with unexplained acute chest pain had more outpatient visits (median, 5 versus 2; p < .0001) and had more often been hospitalized (61.6% ever versus 41.8%; p < .001) during the follow-up period. Several disorders were more common among patients 20 to 25 years later, including atrial fibrillation, esophageal/gastric disorders, chest pain, palpitations, abdominal discomfort, musculoskeletal symptoms, sleeping disturbance, and stress reactions (p values < .05). More patients had been given antihypertensives, anticoagulants, antidepressants, analgesics, and hypnotics/tranquilizers (p values < .05). CONCLUSIONS Young patients admitted to the emergency department with unexplained acute chest pain showed no increased risk of mortality or ischemic heart disease during 25 years of follow-up, but they had higher incidence of a wide range of disorders and used more medications. Early identification and preventive interventions may improve health outcomes in these patients.
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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Metcalfe A, Neudam A, Forde S, Liu M, Drosler S, Quan H, Jetté N. Case definitions for acute myocardial infarction in administrative databases and their impact on in-hospital mortality rates. Health Serv Res 2012; 48:290-318. [PMID: 22742621 DOI: 10.1111/j.1475-6773.2012.01440.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To identify validated ICD-9-CM/ICD-10 coded case definitions for acute myocardial infarction (AMI). DATA SOURCES Ovid Medline (1950-2010) was searched to identify studies that validated acute myocardial infarction (AMI) case definitions. Hospital discharge abstract data and chart data were linked to validate identified AMI definitions. STUDY DESIGN Systematic literature review, chart review, and administrative data analysis. DATA COLLECTION/EXTRACTION METHODS Data on sensitivity/specificity/positive and negative predictive values (PPV and NPV) were extracted from previous studies to identify validated case definitions for AMI. These case definitions were validated in administrative data through chart review and applied to hospital discharge data to assess in-hospital mortality. PRINCIPAL FINDINGS Of the eight ICD-9-CM definitions validated in the literature, use of ICD-9-CM code 410 to define AMI had the highest sensitivity (94 percent) and specificity (99 percent). In our data, ICD-9-CM/ICD-10 codes 410/I21-I22 in all available coding fields had high sensitivity (83.3 percent/82.8 percent) and PPV (82.8 percent/82.2 percent). The in-hospital mortality among AMI patients identified using this case definition was 7.6 percent in ICD-9-CM data and 6.6 percent in ICD-10 data. CONCLUSIONS We recommend that ICD-9-CM 410 or ICD-10 I21-I22 in the primary diagnosis coding field should be used to define AMI. The use of a consistent validated case definition would improve comparability across studies.
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Affiliation(s)
- Amy Metcalfe
- Departments of Community Health Sciences and Clinical Neurosciences, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada, T2N 4Z6.
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Mourad G, Jaarsma T, Hallert C, Strömberg A. Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease. Heart Lung 2012; 41:446-55. [PMID: 22652167 DOI: 10.1016/j.hrtlng.2012.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 03/09/2012] [Accepted: 04/08/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We compared depressive symptoms and healthcare utilization in patients admitted for noncardiac chest pain, acute myocardial infarction, and angina pectoris after hospitalization and at 1-year follow-up. METHODS One hundred and thirty-one patients with noncardiac chest pain, 66 with acute myocardial infarction, and 70 with angina pectoris completed a depression screening questionnaire and the Montgomery Åsberg Depression Rating Scale. Healthcare utilization data were collected from a population-based, diagnosis-related database. RESULTS More than 25% of respondents reported depressive symptoms, regardless of diagnosis. At follow-up, 9% had recovered, 19% were still experiencing depressive symptoms, and 13% had developed depressive symptoms. Noncardiac patients with chest pain had similar primary care contacts, but fewer hospital admissions, than patients with an acute myocardial infarction. Patients with angina pectoris and depressive symptoms used the most healthcare services. CONCLUSIONS Depressive symptoms were common. Patients with noncardiac chest pain used as much primary care as did patients with an acute myocardial infarction. Interventions should focus on identifying and treating depressive symptoms.
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Affiliation(s)
- Ghassan Mourad
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden.
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A 14-year follow-up study of chest pain patients including stress hormones and mental stress at index event. Int J Cardiol 2012; 154:306-11. [PMID: 20961634 DOI: 10.1016/j.ijcard.2010.09.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 09/25/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Knowledge of long-term outcome in chest pain patients is limited. We reinvestigated patients who 14 years earlier had visited the emergency department due to chest pain, and were discharged without hospitalization. Extensive examinations were made at that time on 484 patients including full medical history, exercise test, a battery of stress questions and stress hormone sampling. METHODS From a previously conducted chest pain study patients still alive after 14 years were approached. Hospitalization or deaths with a diagnosis of ischemic heart disease or cerebrovascular disease were used as end point. RESULTS During the follow-up period 24 patients had died with a diagnosis of ischemic heart or cerebrovascular disease, and 50 patients had been given such a diagnosis at hospital discharge. Age (OR 1.12, CI 1.06-1.19), previous history of angina pectoris (OR 9.69, CI 2.06-71.61), pathological ECG at emergency department visit (OR 3.27, CI 1.23-8.67), hypertension (OR 5.03, CI 1.90-13.76), smoking (OR 3.04, CI 1.26-7.63) and lipid lowering medication (OR 14.9, CI 1.60-152.77) were all associated with future ischemic heart or cerebrovascular events. Noradrenalin levels were higher in the event group than in the non-event group, mean (SD) 2.44 (1.02) nmol/L versus 1.90 (0.75) nmol/L. When noradrenalin was included in the regression model high maximal exercise capacity was protective of an event (OR 0.986, CI 0.975-0.997). CONCLUSION In chest pain patients previous history of angina pectoris, hypertension, smoking, pathological ECG at primary examination, and age were the main risk factors associated with future cardiovascular or cerebrovascular events.
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Gillies M, Jhund PS, MacTeague K, MacIntyre P, Allardyce J, Batty GD, MacIntyre K. Prior psychiatric hospitalization is associated with excess mortality in patients hospitalized with non-cardiac chest pain: a data linkage study based on the full Scottish population (1991-2006). Eur Heart J 2011; 33:760-7. [DOI: 10.1093/eurheartj/ehr401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khattar RS, Nair SB, Hamid T, Chacko S, Mamas M, Turkie W, Arumugam P. Prognostic value of demographic factors, pre-test probability scoring, exercise test diagnosis, and inability to exercise in patients with recent onset suspected cardiac chest pain. Eur J Prev Cardiol 2011; 19:419-27. [DOI: 10.1177/1741826711404505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: To assess the prognostic value of an inconclusive exercise test or inability to exercise in patients with recent onset suspected cardiac chest pain and to determine the independent predictors of events in these patients. Methods: This was an observational follow-up study of patients presenting to a rapid access chest pain clinic with a history of recent-onset suspected cardiac chest pain as referred by the family practitioner. The main outcome measure was a composite endpoint of death and acute coronary syndrome hospital admission. Results: The study cohort consisted of 1851 patients in whom a total of 147 events were recorded during a mean follow-up period of 4.1 ± 1.1 years. Those with events were significantly older (65.1 ± 12.5 years versus 56.4 ± 13.2 years, p < 0.001), had higher mean pre-test probability of coronary artery disease (CAD), and had higher prevalence of diabetes (18.4% vs. 13.6%, p < 0.001), hypertension (55.8% vs. 38.7%, p < 0.001), and smoking (36.7% vs. 25.4%, p = 0.03) than those without events. These patients were also more likely to have a positive exercise electrocardiogram (ECG) (15.6% vs. 8.6%, p < 0.001) or not have a diagnostic exercise test because of an inconclusive result or inability to exercise (60.5% vs. 28.6%, p < 0.001). Cox multivariate regression analysis showed that age (hazard ratio, HR 1.03, p < 0.001), pre-test probability of CAD (HR 1.08, p = 0.04), positive exercise ECG (HR 2.94, p < 0.001), and an inconclusive test or inability to exercise (HR 3.45, p < 0.001) were independent predictors of events. Conclusions: In patients with recent onset suspected cardiac chest pain, not having a diagnostic exercise ECG because of an inconclusive test or inability to exercise is an independent predictor of events and has similar prognostic implications to a positive exercise ECG. In addition, pre-test probability estimation at baseline is a robust indicator of clinical outcome. Future models of care need to incorporate early and increased access to non-exercise cardiac imaging techniques in order to meet the needs of this high-risk subgroup of patients.
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Affiliation(s)
- Rajdeep S Khattar
- Manchester Heart Centre, Manchester Royal Infirmary and The University of Manchester, Manchester, UK
| | - Satheesh B Nair
- Manchester Heart Centre, Manchester Royal Infirmary and The University of Manchester, Manchester, UK
| | - Tahir Hamid
- Manchester Heart Centre, Manchester Royal Infirmary and The University of Manchester, Manchester, UK
| | - Sanoj Chacko
- Manchester Heart Centre, Manchester Royal Infirmary and The University of Manchester, Manchester, UK
| | - Mamas Mamas
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Wajdi Turkie
- Manchester Heart Centre, Manchester Royal Infirmary and The University of Manchester, Manchester, UK
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Manchester Royal Infirmary, Manchester, UK
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Sekhri N, Timmis A, Chen R, Junghans C, Walsh N, Zaman MJ, Eldridge S, Hemingway H, Feder G. Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris. BMJ 2008; 336:1058-61. [PMID: 18436918 PMCID: PMC2376033 DOI: 10.1136/bmj.39534.571042.be] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether coronary angiography for suspected stable angina pectoris is underused in older patients, women, south Asian patients, and those from socioeconomically deprived areas, and, if it is, whether this is associated with higher coronary event rates. DESIGN Multicentre cohort with five year follow-up. SETTING Six ambulatory care clinics in England. PARTICIPANTS 1375 consecutive patients in whom coronary angiography was individually rated as appropriate with the Rand consensus method. MAIN OUTCOME MEASURES Receipt of angiography (420 procedures); coronary mortality and acute coronary syndrome events. RESULTS In a multivariable analysis, angiography was less likely to be performed in patients aged over 64 compared with those aged under 50 (hazard ratio 0.60, 95% confidence interval 0.38 to 0.96), women compared with men (0.42, 0.35 to 0.50), south Asians compared with white people (0.48, 0.34 to 0.67), and patients in the most deprived fifth compared with the other four fifths (0.66, 0.40 to 1.08). Not undergoing angiography when it was deemed appropriate was associated with higher rates of coronary event. CONCLUSIONS At an early stage after presentation with suspected angina, coronary angiography is underused in older people, women, south Asians, and people from deprived areas. Not receiving appropriate angiography was associated with a higher risk of coronary events in all groups. Interventions based on clinical guidance that supports individualised management decisions might improve access and outcomes.
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Affiliation(s)
- Neha Sekhri
- Cardiac Directorate, Barts and the London NHS Trust, London
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