Editorials

Chest pain in primary care: what happens to the undiagnosed majority?

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1626 (Published 03 April 2017) Cite this as: BMJ 2017;357:j1626
  1. Tim Holt, senior clinical research fellow
  1. tim.holt{at}phc.ox.ac.uk

Pain without a diagnosis may signal higher cardiovascular risk

Acute chest pain is an alarming symptom, and the exclusion of a cardiac or other serious cause is the first priority. Through the process a proportion of patients undergo investigation and in some cases coronary heart disease is confirmed, a definite non-cardiac diagnosis is made, or the cause is unattributed. Assessment of new onset chest pain is typically based on the pattern and characteristics of the pain in the context of background cardiovascular risk. In a linked paper, Jordan and colleagues (doi:10.1136/bmj.j1194) show that most patients are managed without undergoing cardiac investigations.1 The unattributed group, whether investigated or not, have a greater risk of myocardial infarction over the next five years than those with a more definite non-cardiac diagnosis, as we might expect. More surprisingly, their volume in terms of patient numbers is sufficient such that more myocardial infarctions occur over the following five years in this group than those labelled …

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