Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
J Intern Med. 2019 Nov;286(5):562-572. doi: 10.1111/joim.12948. Epub 2019 Jul 19.
The prognosis of unexplained chest pain patients provides valuable information for evaluation of health services.
To examine prognosis of unexplained chest pain.
Using data from in- and outpatient hospital visits in Norway of patients discharged with a main diagnosis of unexplained chest pain (ICD-10: R072-R074) in 2010-2012, the 1-year incidence of coronary heart disease (CHD), any cardio-vascular disease (CVD) and mortality was evaluated. Cases with prior 2-year history of CVD or chest pain were excluded. Cox proportional hazards evaluated outcomes by patient characteristics and standardized mortality ratios evaluated observed versus expected mortality.
Of 59 569 patients identified (20-89 years of age), the majority (86%) were referred to hospital by out-of-hours emergency care centres. Subsequent CHD was noted for 12.5%, 19.5% and 25.0% of men and 7.2%, 11.0%, 14.0% of women aged 45-64, 65-74 and 75-89 years, respectively. The per cent of deaths attributed to CVD were greatest within the first 2 months of postdischarge. Total mortality rates (per 1000 person-years) were 6.6 in men and 4.7 in women aged 45-64 and 69.2 in men and 39.5 in women aged 75-89 years. Relative to the general population, mortality was 53% and 45% higher for men and women under 65 years of age, respectively, attributed primarily to non-CVD causes.
Patients in Norway discharged with unexplained chest pain are an at-risk group in terms of incident CHD, any CVD and mortality, including non-CVD mortality during the first-year postdischarge. The results suggest that unexplained chest pain patients may benefit from greater healthcare coordination between medical disciplines.
不明原因胸痛患者的预后为评估卫生服务提供了有价值的信息。
检查不明原因胸痛的预后。
利用 2010-2012 年挪威门诊和住院患者的就诊数据，对出院时主要诊断为不明原因胸痛（ICD-10：R072-R074）的患者进行了 1 年冠心病（CHD）、任何心血管疾病（CVD）和死亡率的发病率评估。排除了有 2 年 CVD 或胸痛病史的病例。Cox 比例风险评估了患者特征的结果，标准化死亡率比评估了观察到的与预期的死亡率。
在所确定的 59569 例患者中（20-89 岁），大多数（86%）是由夜间急救中心转来的。45-64 岁、65-74 岁和 75-89 岁的男性和女性中，随后发生 CHD 的比例分别为 12.5%、19.5%和 25.0%，分别为 7.2%、11.0%和 14.0%。出院后 2 个月内，归因于 CVD 的死亡百分比最高。总死亡率（每 1000 人年）在 45-64 岁的男性和女性中为 6.6，在 75-89 岁的男性和女性中为 4.7。与一般人群相比，65 岁以下男性和女性的死亡率分别高出 53%和 45%，主要归因于非 CVD 原因。
挪威因不明原因胸痛而出院的患者在发生 CHD、任何 CVD 和死亡率方面存在风险，包括出院后第一年的非 CVD 死亡率。结果表明，不明原因胸痛患者可能受益于医学学科之间更大的医疗协调。
