Fewer than half of individuals who have "non-specific" chest pain (not explained by a well-known condition) experience relief from symptoms following standard medical care, according to a report in the February 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In addition, one-tenth of those with persistent chest pain undergo potentially unnecessary diagnostic testing.
More than half of patients with chest pain are classified as not having an underlying heart condition, according to background information in the article. Some have another well-established medical condition, such as upper respiratory tract infection, but for many no pathophysiologic cause can be found. Such non-specific chest pain "is a frequent phenomenon in primary care," the authors write. "However, knowledge about the course and outcome of this condition is sparse."
Julia Anna Glombiewski, Ph.D., of Philipps-University of Marburg, Germany, and colleagues studied 807 patients (average age 57.6 years) with non-specific chest pain who visited 74 German primary care offices in 2005 and 2006. The clinicians recorded their preliminary diagnoses, along with any investigations and treatments related to their patients' chest pain. Patients were contacted by phone six weeks and then six months after the initial consultation.
Among the 755 study patients who provided data at the six-month follow-up, 419 (55.5 percent) still had chest pain. In addition, 45 (10.7 percent) of those were categorized as using health care in an inappropriate manner, defined as two or more visits to a cardiologist or three or more cardiac diagnostic evaluations-including angiograms and electrocardiograms-within six months. This compared with 24 (7.1 percent) of 336 patients with remitted chest pain.