Nonspecific chest pain in primary care practice

January 01, 0001

Nonspecific chest pain in primary care practice

These German authors conducted a prospective, general physician-based cohort study with 6-week and 6-month follow-ups in 74 primary care offices in Hessen, Germany. Of approximately 190,000 consecutive patients who visited their general physicians 807 patients with nonspecific chest pain were identified by an expert committee. The dropout rate was 2.7%. Main outcome measures were persistent chest pain and health care usage at 6 months.

They found: "The rate of persistent chest pain was 55.5%. A total of 10.7% of patients had inappropriate health care usage, defined as 2 or more visits to a cardiologist or 3 or more cardiac diagnostic investigations. Most patients with persistent nonspecific chest pain were referred to a cardiologist, and less than 2% were referred to mental health specialists."

The authors concluded: "For most patients with nonspecific chest pain, standard medical care does not offer sufficient help for symptom relief. One-tenth of patients with persistent chest pain underwent additional diagnostic testing of no known clinical benefit. Psychological referrals were rarely given."

The physicians were probably concerned about missing a cardiac diagnosis, even if they realized it was unlikely.

For the full abstract, click here.

Arch Intern Med 170(3):251-255, 8 Feb 2010
© 2010 to the American Medical Association
The Course of Nonspecific Chest Pain in Primary Care-Symptom Persistence and Health Care Usage. Julia Anna Glombiewski, Winfried Rief, Stefan Bösner, Heidemarie Keller, Alexandra Martin, Norbert Donner-Banzhoff. Correspondence to Dr. Glombiewski: [email protected]

Category: A. General/Unspecified, K. Circulatory, P . Psychological. Keywords: chest pain, nonspecific, general practice, health care usage, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 2 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.