ArticleBMJ open2015
Clinical value of chest pain presentation and prodromes on the assessment of cardiovascular disease: a cohort study.
Article in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
7 citing papers in PubMed, 19 citations in OpenAlex.
- Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study.European journal of preventive cardiology · 2023Article
- Long-Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study.Journal of the American Heart Association · 2022Article
- Antibiotic overuse in the primary health care setting: a secondary data analysis of standardised patient studies from India, China and Kenya.BMJ global health · 2020Article
- Chest pain and shortness of breath in cardiovascular disease: a prospective cohort study in UK primary care.BMJ open · 2017Article
- Prognosis of undiagnosed chest pain: linked electronic health record cohort study.BMJ (Clinical research ed.) · 2017Article
- Depression and chest pain in patients with coronary artery disease.International journal of cardiology · 2017Article
- Presentation of Coronary Artery Disease in a Chiropractic Clinic: A Report of 2 Cases.Journal of chiropractic medicine · 2016Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesThe recognition of coronary artery disease (CAD) among patients who report chest pain remains difficult in primary care. This study investigates the association between chest pain (specified, unspecified or musculoskeletal) and prodromes (dyspepsia, fatigue or dyspnoea), with first-ever acute CAD, and increased longer term cardiovascular risk.
designCohort study.
settingAnonymised clinical data recorded electronically by general practitioners from 140 primary care surgeries in London (UK) between April 2008 and April 2013.
participantsData were extracted for all patients aged 30 years and over at the beginning of the study period, registered in the surgeries.
main outcome measuresClinical data included chest pain, dyspepsia, dyspnoea and fatigue, first-ever CAD and long-term cardiovascular risk (QRisk2). Regression models were used to analyse the association between chest pain together with prodromes and CAD and QRisk2≥20%.
results354,052 patients were included in the study. 4842 patients had first-ever CAD of which 270 reported chest pain in the year before the acute event. 257,019 patients had QRisk2 estimations. Chest pain was associated with a higher risk of CAD. HRs: 21.12 (16.68 to 26.76), p<0.001; 7.51 (6.49 to 8.68), p<0.001; and 1.84 (1.14 to 3.00), p<0.001 for specified, unspecified and musculoskeletal chest pain. Dyspepsia, dyspnoea or fatigue was also associated with a higher risk of CAD. Chest pain of all subtypes, dyspepsia and dyspnoea were also associated with an increased 10-year cardiovascular risk of 20% or more.
conclusionsAll patients with chest pain, including those with atypical symptoms, require careful assessment for acute and longer term cardiovascular risk. Prodromes may have independent diagnostic value in the estimation of cardiovascular disease risk.
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