Materiały źródłowe

• #1 Chest pain epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Chest_pain_epidemiology_and_demographics

  There is a significant difference in the epidemiology of chest pain in outpatient and emergency settings. The incidence of chest pain is approximately 1,500 per 100,000 individuals worldwide. According to a study conducted in Belgium, the prevalence of chest pain is approximately 2000-5000 per 100,000 individuals worldwide. The incidence of patients presenting with chest pain increases with age and men are more likely to present with chest pain than women. […] The incidence of chest pain is approximately 1,500 per 100,000 individuals worldwide. […] A cross-sectional study conducted in Germany and published in 2016, found the incidence of chest pain was estimated to be 700-3000 cases per 100,000 individuals worldwide. […] Approximately a quarter of the population experiences chest pain in some form during their lifetime.

• #2 Chest pain epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Chest_pain_epidemiology_and_demographics

  According to a study conducted in Belgium, the prevalence of chest pain is approximately 2000-5000 per 100,000 individuals worldwide. […] The mortality rate of chest pain is approximately 3%. […] Patients with a myocardial infarction that presented without chest pain had a mortality rate of 23.3% compared with 9.3% in patients who had chest pain as a presentation. […] The incidence of patients presenting with chest pain increases with age; the median age being 53 years. […] Men are more likely to present with chest pain than women.

• #3 Approach to the adult with nontraumatic chest pain in the emergency department – UpToDate

  https://www.uptodate.com/contents/evaluation-of-the-adult-with-chest-pain-in-the-emergency-department

  Chest pain is the second most common complaint in adult emergency departments (ED) patients in the United States (US), accounting for 6 to 7 percent (between 7 and 8 million) of annual visits. Most visits result in a diagnosis of noncardiac chest pain, and approximately half do not have a specific cause identified and thus are considered to have nonspecific chest pain. Approximately 6 percent are ultimately diagnosed with a life-threatening condition, which is overwhelmingly (>90 percent) acute coronary syndrome. The risk of a life-threatening diagnosis increases with advancing age. […] Clinicians in the ED focus on the immediate recognition and exclusion of life-threatening causes of chest pain. Patients with life-threatening etiologies for chest pain may appear deceptively well, manifesting neither vital sign nor physical examination abnormalities.

• #4 Chest Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470557/

  Chest pain is a common complaint and encompasses a broad differential diagnosis that includes several life-threatening causes. […] In the emergency department, chest pain is the second most common complaint comprising approximately 5% of all emergency department visits. […] In evaluating for chest pain, the provider should always consider life-threatening causes of chest pain. […] These are listed below with approximate percent occurrence in patients presenting to the emergency department with chest pain based on a study by Fruerfaard et al. […] Other common causes of chest pain with approximate percent occurrence in patients presenting to the emergency department with chest pain include:

• #5 Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria

  https://scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362016000100010

  Chest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED) […] The aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa. […] The prevalence of chest pain in the ED was found to be 1.82% (traumatic and non-traumatic). The prevalence of non-traumatic chest pain was 1.66%. […] The most common cause of acute chest pain was found to be respiratory disease (36.19%), followed by musculoskeletal conditions (21.9%) and cardiovascular disease (21.43%). […] The main cause of acute chest pain in the ED of Kalafong Hospital, South Africa, was found to be respiratory disease, followed by acute cardiovascular disease. […] In the African context, the aetiology of acute chest pain differs widely from first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.

• #6 Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4926718/

  The prevalence of chest pain in the ED was found to be 1.82% (traumatic and non-traumatic). The prevalence of non-traumatic chest pain was 1.66%. […] The most common cause of acute chest pain was found to be respiratory disease (36.19%), followed by musculoskeletal conditions (21.9%) and cardiovascular disease (21.43%). […] The probability of being admitted was highest for patients with acute cardiovascular disease, acute respiratory disease, older age, and patients transported by ambulance, whereas the probability of being discharged was the highest for patients with musculoskeletal disorders. […] In the African context, the aetiology of acute chest pain differs widely from first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.

• #7 JLE – Annales françaises de médecine d’urgence – Epidemiology of acute chest pain in the emergency department of Nice University Hospital

  https://www.jle.com/en/revues/fmu/e-docs/epidemiologie_des_douleurs_thoraciques_prises_en_charge_dans_le_service_des_urgences_du_centre_hospitalier_universitaire_de_nice_340706/article.phtml

  Epidemiology of acute chest pain in the emergency department of Nice University Hospital […] Acute chest pain is a chief complaint in the emergency department (ED) of western countries. Our purpose was to describe the epidemiology of patients visiting the ED of a tertiary teaching hospital for chest pain during 2011. […] Chest pain represented 3% of emergency visits. We observed 5% myocardial infarction, 69% were male and 31% female. Average age was 62 15 years and of 73 13 years for men and women, respectively. More than 40% chest pain patients were discharged without definite diagnosis. […] Chest pain is a frequent complaint for visiting the emergency department. Few patients present with acute cardiac disorders. Too many patients are discharged without diagnosis.

• #8 Chest Pain in the Emergency Department: Incidence, Clinical Characteristics, and Risk Stratification – Revista Española de Cardiología

  https://www.revespcardiol.org/es-chest-pain-in-theemergency-articulo-13125893

  Introduction and objectives. Although chest pain is a common presenting symptom in emergency departments, its clinical management is highly variable. Our aims were to describe the characteristics of patients with chest pain and to evaluate the usefulness of the CPU-65 index for risk stratification. […] Evaluation of patients with chest pain is one of the biggest challenges facing physicians who work in emergency departments. This complaint accounts for between 5% and 20% of all admissions to the emergency department and it is estimated that one emergency for chest pain is attended for every 1000 inhabitants covered by a referral hospital. […] In our study, we found that patients who present in the emergency department with chest pain represent an enormous healthcare burden, and this confirms previous findings (approximately 1 admission to the emergency department/month per 1000 inhabitants). […] Half of the patients who presented at the emergency department with chest pain have a very low risk profile and so their admission to a CPU (real or virtual) and, probably, measurement of markers of myocardial damage might not be necessary.

• #9 Characteristics of chest pain and its acute management in a low-middle income country: analysis of emergency department surveillance data from Pakistan | BMC Emergency Medicine | Full Text

  https://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-15-S2-S13

  Examining the prevalence of chest pain – both angina (cardiac) and non-anginal (non-cardiac) – and its characteristics in LMICs is critical for developing targeted interventions for the management of chest pain patients in EDs and potentially stemming an epidemic of premature coronary deaths. […] During the Pak-NEDS study period, 20,435 patients were admitted to the EDs with chest pain as a major complaint. […] Less than 20% of all patients with chest pain were admitted to the hospital. This is a relatively low number of admission compared to findings in the US (35%) but comparable to findings in the UK (25%). […] The findings of this study showed a high burden of chest pain in Pakistan, with higher numbers in younger adults.

• #10 Characteristics of chest pain and its acute management in a low-middle income country: analysis of emergency department surveillance data from Pakistan | BMC Emergency Medicine | Full Text

  https://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-15-S2-S13

  Chest pain is one of the most frequent causes of emergency department (ED) visits in high-income countries. Little is known about chest pain patients presenting to EDs of low- and middle-income countries (LMICs). The objective of this study was to describe the characteristics of chest pain patients presenting to emergency departments (EDs) of Pakistan and to determine the utilization of ED resources in the management of chest pain patients and their outcomes. […] A total of 20,435 patients were admitted to the EDs with chest pain. The majority were males (M 60%, F 40%) and the mean age was 42 years (SD+/- 14). […] Chest pain is a common presenting complaint in EDs in Pakistan. The majority received an ECG and the use of diagnostic testing, such as cardiac enzymes, is quite uncommon. […] The burden of cardiovascular disease in low-and middle-income countries (LMICs) has gained increased attention, though population-based data on the prevalence of chest pain in developing countries is lacking.

• #11 Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4926718/

  Chest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED). […] The aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa. […] The prevalence of non-traumatic chest pain was 1.66%. Respiratory disease was the most common cause (36.19%), with pneumonia the most common diagnosis (24.40%). […] The main cause of acute chest pain was found to be respiratory disease, followed by musculoskeletal disorders. In the African context, the aetiology of acute chest pain differs from that in first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.

• #12 Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4926718/

  The prevalence of chest pain in the ED was found to be 1.82% (traumatic and non-traumatic). The prevalence of non-traumatic chest pain was 1.66%. […] The most common cause of acute chest pain was found to be respiratory disease (36.19%), followed by musculoskeletal conditions (21.9%) and cardiovascular disease (21.43%). […] The probability of being admitted was highest for patients with acute cardiovascular disease, acute respiratory disease, older age, and patients transported by ambulance, whereas the probability of being discharged was the highest for patients with musculoskeletal disorders. […] In the African context, the aetiology of acute chest pain differs widely from first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.

• #13 Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria | Geyser | African Journal of Primary Health Care & Family Medicine

  https://phcfm.org/index.php/phcfm/article/view/1048

  Chest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED). […] The aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa. […] Of the 312 patients presenting with chest pain, 210 patient files were retrieved. The prevalence of non-traumatic chest pain was 1.66%. […] The main cause of acute chest pain was found to be respiratory disease, followed by musculoskeletal disorders. In the African context, the aetiology of acute chest pain differs from that in first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.

• #14 Epidemiology of Chest Pain at the University Hospital Center-Référence Nationale (CHU-RN) of N’Djamena, Cardiology and Cardiovascular Research, Science Publishing Group

  https://www.sciencepg.com/article/10.11648/j.ccr.20230701.13

  Epidemiology of Chest Pain at the University Hospital Center-Rfrence Nationale (CHU-RN) of N’Djamena […] Introduction: Chest pain is a frequent reason for consultation in Internal Medicine and especially in cardiology. Few data are available on this condition in Chad. The aim of this work was to describe its epidemiological characteristics. […] Results: A total of 146 patients were included in the study. The mean age was 46.1 16.3 years. The sex ratio was 0.8 in favor of women. Arterial hypertension was the main cardiovascular risk factor found (41.9%). The pain was epigastric in 41.9% of cases and retrosternal in 23.7% of cases. Dyspnea was the most common associated sign (29.9%). Etiologies were dominated by cardiac (56.4%) and digestive (46.2%) causes. The main cardiovascular etiology was coronary insufficiency (42.4%). Regarding digestive causes, they were dominated by gastropathies and gastroduodenal ulcer disease (40.2%). In 17.1% of cases the chest pain was of pulmonary origin. […] Conclusion: Chest pain is a frequent reason for consultation. The etiologies are diverse. Apart from the cardiovascular causes likely to compromise the vital prognosis, we must not lose sight of the digestive and pulmonary causes.

• #15 Epidemiology of Chest Pain at the University Hospital Center-Référence Nationale (CHU-RN) of N’Djamena, Cardiology and Cardiovascular Research, Science Publishing Group

  http://ccresj.org/article/10.11648/j.ccr.20230701.13

  Epidemiology of Chest Pain at the University Hospital Center-Rfrence Nationale (CHU-RN) of N’Djamena. Chest pain is a frequent reason for consultation in Internal Medicine and especially in cardiology. Few data are available on this condition in Chad. The aim of this work was to describe its epidemiological characteristics. A total of 146 patients were included in the study. The mean age was 46.1 16.3 years. The sex ratio was 0.8 in favor of women. Arterial hypertension was the main cardiovascular risk factor found (41.9%). The pain was epigastric in 41.9% of cases and retrosternal in 23.7% of cases. Dyspnea was the most common associated sign (29.9%). Etiologies were dominated by cardiac (56.4%) and digestive (46.2%) causes. The main cardiovascular etiology was coronary insufficiency (42.4%). Regarding digestive causes, they were dominated by gastropathies and gastroduodenal ulcer disease (40.2%). In 17.1% of cases the chest pain was of pulmonary origin. Chest pain is a frequent reason for consultation. The etiologies are diverse. Apart from the cardiovascular causes likely to compromise the vital prognosis, we must not lose sight of the digestive and pulmonary causes.

• #16 Evaluation of Chest Pain in Primary Care Patients | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0301/p603.html

  Chest pain can be caused by conditions that range from benign and self-limited (e.g., chest wall pain) to serious (e.g., anxiety disorder) or life-threatening (e.g., unstable angina, aortic dissection, pulmonary embolism). Accurate identification of life-threatening and serious causes of chest pain must be accomplished without overtesting and overtreating patients with less serious causes. The first step in clinical diagnosis is knowing the pretest probability of different causes of chest pain. […] Based on these studies, approximately 40 percent of patients presenting with chest pain have musculoskeletal causes, 12 percent have stable angina, 3 percent have acute cardiac ischemia (including myocardial infarction [MI]), and less than 1 percent have pulmonary embolism. […] Musculoskeletal conditions (e.g., costochondritis, Tietze syndrome, costosternal syndrome) are the least serious causes of chest pain.

• #17 Evaluation of Chest Pain in Primary Care Patients | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0301/p603.html

  Chest pain can be caused by conditions that range from benign and self-limited (e.g., chest wall pain) to serious (e.g., anxiety disorder) or life-threatening (e.g., unstable angina, aortic dissection, pulmonary embolism). Accurate identification of life-threatening and serious causes of chest pain must be accomplished without overtesting and overtreating patients with less serious causes. The first step in clinical diagnosis is knowing the pretest probability of different causes of chest pain. […] Based on these studies, approximately 40 percent of patients presenting with chest pain have musculoskeletal causes, 12 percent have stable angina, 3 percent have acute cardiac ischemia (including myocardial infarction [MI]), and less than 1 percent have pulmonary embolism. […] Musculoskeletal conditions (e.g., costochondritis, Tietze syndrome, costosternal syndrome) are the least serious causes of chest pain.

• #18 Chest Pain: Assessment and Treatment | Doctor

  https://patient.info/doctor/chest-pain-pro

  European Society of Cardiology (ESC) guidelines report that among unselected patients presenting with acute chest pain to the emergency department, disease prevalence can be expected to be the following: 5-10% ST-segment elevation myocardial infarction (STEMI), 15-20% non-STEMI (NSTEMI), 10% unstable angina, 15% other cardiac conditions, and 50% non-cardiac diseases. […] Combined hospital and primary care data produced an incidence of cardiac chest pain of 6.5 per 1,000 general population per annum. […] Population-based questionnaire studies show about 20% of adults reporting chest pain over the course of a year. This reflects the chronicity of coronary heart disease but also low consultation rates, particularly in those without a diagnosis of cardiac disease. […] The incidence of chest pain consultations increases with age and is more common for men.

• #19 Prevalence of musculoskeletal chest pain in the emergency department: a systematic review and meta-analysis

  https://www.degruyter.com/document/doi/10.1515/sjpain-2020-0168/html?lang=en

  Our objective was to systematically review and meta-analyse relevant studies to determine the prevalence of musculoskeletal chest pain in the emergency department. […] A meta-analysis of the nine included studies, having a total of 14,743 participants, showed the global pooled prevalence of musculoskeletal chest pain in the emergency department to be 16% (10-22%). The pooled prevalence for the European continent was 17% (9-25%) and that for the urban areas was 13% (7-19%). […] This review provides a reliable estimate of the prevalence of musculoskeletal chest pain in the emergency department. […] Based on the limited and low-quality evidence this systematic review concludes the global pooled prevalence of MSCP in the ED to be 16% (10-22%). The prevalence value for the European continent is 17% (9-25%), and that for the urban areas is 13% (7-19%).

• #20 Chest pain in pediatric patients in the emergency department- Presentation, risk factors and outcomes-A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0294461

  This study showed that cardiac causes of chest pain are rare in children. More specifically, our study shows that only 2.5% of our study population had chest pain that was secondary to a cardiac cause. This supports the previous findings that cardiac-related causes for chest pain in children are very rare. […] Our review found 97.5% of our study population have a non-cardiac induced presentation of chest pain. The alternative causes of chest pain reported were respiratory, gastrointestinal, psychogenic, musculoskeletal, and idiopathic. The most prevalent non-cardiac cause of chest pain was musculoskeletal followed by idiopathic and then gastrointestinal. This is consistent with previous studies which have found these causes to be among the most common non-cardiac causes of pediatric chest pain.

• #21 Chest pain in pediatric patients in the emergency department- Presentation, risk factors and outcomes-A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0294461

  This study showed that cardiac causes of chest pain are rare in children. More specifically, our study shows that only 2.5% of our study population had chest pain that was secondary to a cardiac cause. This supports the previous findings that cardiac-related causes for chest pain in children are very rare. […] Our review found 97.5% of our study population have a non-cardiac induced presentation of chest pain. The alternative causes of chest pain reported were respiratory, gastrointestinal, psychogenic, musculoskeletal, and idiopathic. The most prevalent non-cardiac cause of chest pain was musculoskeletal followed by idiopathic and then gastrointestinal. This is consistent with previous studies which have found these causes to be among the most common non-cardiac causes of pediatric chest pain.

• #22 Chest Wall Pain Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/chest-wall-pain-syndrome/

  In the primary care setting, CWPS has a mean age SD of 50.318 years, with nearly equal occurrence in men and women. It accounts for nearly 50% of all complaints in the ambulatory and emergency room setting. CWPS is the principal cause of pain in 44.6% of patients who present with thoracic pain. Additionally, 83% of patients will also have associated comorbidity, including psychiatric dysfunction (50%), cardiovascular disease (33%), coronary disease (19%), and rheumatologic conditions (20.7%). Approximately 2% of patients have primary non-specified lung carcinomas (33%) or non-specific metastatic neoplastic disease (67%). Among pediatric patients, 31% have nonspecific chest pain. In adolescents, costochondritis accounts for 14% of chest wall pain. […] Despite the vast number of admissions for chest pain, the process involved with the diagnosis of non-cardiac causes for chest pain very often ends up as a diagnosis of exclusion. The sheer number of possible diagnoses/factors for chest pain make high quality randomized, double blinded studies extremely hard to conduct. As a result, definitive conclusions about chest wall pain are difficult to reach due to the lack of sufficient evidence.

• #23 Angina Pectoris: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/150215-overview

  Approximately 9.8 million Americans are estimated to experience angina annually, with 500,000 new cases of angina occurring every year. […] In 2009, an estimated 785,000 Americans will have a new coronary attack, and about 470,000 will have a recurrent attack. Only 18% of coronary attacks are preceded by angina. An additional 195,000 silent first myocardial infarctions are estimated to occur each year. […] Angina pectoris is more often the presenting symptom of coronary artery disease in women than in men, with a female-to-male ratio of 1.7:1. It has an estimated prevalence of 4.6 million in women and 3.3 million in men. […] The prevalence of angina pectoris increases with age. Age is a strong independent risk factor for mortality. More than 150,000 Americans killed by CVD in 2005 were younger than 65 years. However, in 2005, 32% of deaths from cardiovascular disease occurred before the age of 75 years, which is well before the average life expectancy of 77.9 years.

• #24 Chest Pain in the Emergency Department — CWHHA | Homepage

  https://www.cwhha.ca/chest-pain-in-the-er

  Women are 7 times more likely to be sent home from the Emergency Department. […] Cardiovascular disease (CVD) is the leading cause of premature death in women in Canada. […] More than 50% of women who experience heart attacks have their symptoms unrecognized by healthcare providers. […] Chest discomfort is the most common presenting complaint in 90% of ACS, in BOTH men and women. […] Assessing for cardiac disease should be prioritized in women who experience chest pain/pressure. […] In 5-15% of ACS cases, MINOCA can occur, particularly in women. […] Long term prognosis for MINOCA patients may include worse quality of life indicators, compared to obstructive MI patients. […] Possible causes of MINOCA include, but are not limited to, plaque rupture/erosion, coronary artery vasospasm, microvascular dysfunction, coronary artery embolism, and spontaneous coronary artery dissection (SCAD). […] Beyond MINOCA, elevated troponin levels may also be found in other non-obstructive coronary artery conditions such as myocarditis, stress (Tako-tsubo) cardiomyopathy and non-ischemic critical conditions such as sepsis, pulmonary embolism, chronic kidney disease and aortic dissection.

• #25 Chest Pain in the Emergency Department — CWHHA | Homepage

  https://www.cwhha.ca/chest-pain-in-the-er

  Women are 7 times more likely to be sent home from the Emergency Department. […] Cardiovascular disease (CVD) is the leading cause of premature death in women in Canada. […] More than 50% of women who experience heart attacks have their symptoms unrecognized by healthcare providers. […] Chest discomfort is the most common presenting complaint in 90% of ACS, in BOTH men and women. […] Assessing for cardiac disease should be prioritized in women who experience chest pain/pressure. […] In 5-15% of ACS cases, MINOCA can occur, particularly in women. […] Long term prognosis for MINOCA patients may include worse quality of life indicators, compared to obstructive MI patients. […] Possible causes of MINOCA include, but are not limited to, plaque rupture/erosion, coronary artery vasospasm, microvascular dysfunction, coronary artery embolism, and spontaneous coronary artery dissection (SCAD). […] Beyond MINOCA, elevated troponin levels may also be found in other non-obstructive coronary artery conditions such as myocarditis, stress (Tako-tsubo) cardiomyopathy and non-ischemic critical conditions such as sepsis, pulmonary embolism, chronic kidney disease and aortic dissection.

• #26 Sex Differences in Acute Chest Pain Care

  https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2023/03/08/15/34/sex-differences-in-epidemiology

  In general, women presenting with chest pain are less likely to have cardiovascular disease. However, among patients with STEMI, women have worse outcomes. […] Delays in guideline-directed care were noted for women during the prehospitalization and hospitalization management. […] Efforts to improve guideline-directed care for women may need to include sex-specific reporting for key performance measures. […] A total of 256,901 EMS attendances for chest pain occurred during the study period, of which 129,096 (50.3%) were for female patients. […] In multivariable models, women were less likely to receive guideline-directed care across most care measures, including transport to the hospital, prehospital aspirin or analgesia administration, 12-lead ECG, IV cannula insertion, and off-load from EMS or review by ED clinicians within target times.

• #27 Sex Differences in Acute Chest Pain Care

  https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2023/03/08/15/34/sex-differences-in-epidemiology

  Women with ACS were less likely to undergo angiography or be admitted to a cardiac or intensive care unit. […] Thirty-day and long-term mortality were higher for women diagnosed with ST-elevation myocardial infarction (STEMI) but lower overall. […] The authors concluded that substantial differences in care are present across the spectrum of acute chest pain management from first contact through to hospital discharge. […] These data suggest the need for ongoing efforts to reduce gender-related differences in care for chest pain.

• #28 Chest Pain in the Emergency Department — CWHHA | Homepage

  https://www.cwhha.ca/chest-pain-in-the-er

  Women are 7 times more likely to be sent home from the Emergency Department. […] Cardiovascular disease (CVD) is the leading cause of premature death in women in Canada. […] More than 50% of women who experience heart attacks have their symptoms unrecognized by healthcare providers. […] Chest discomfort is the most common presenting complaint in 90% of ACS, in BOTH men and women. […] Assessing for cardiac disease should be prioritized in women who experience chest pain/pressure. […] In 5-15% of ACS cases, MINOCA can occur, particularly in women. […] Long term prognosis for MINOCA patients may include worse quality of life indicators, compared to obstructive MI patients. […] Possible causes of MINOCA include, but are not limited to, plaque rupture/erosion, coronary artery vasospasm, microvascular dysfunction, coronary artery embolism, and spontaneous coronary artery dissection (SCAD). […] Beyond MINOCA, elevated troponin levels may also be found in other non-obstructive coronary artery conditions such as myocarditis, stress (Tako-tsubo) cardiomyopathy and non-ischemic critical conditions such as sepsis, pulmonary embolism, chronic kidney disease and aortic dissection.

• #29 A study identifies the signs of a heart attack that are least recognized by the population | Universidad de Granada

  https://www.ugr.es/en/about/news/signs-heart-attack-are-least-recognized-population

  Seeking medical care is more likely to be delayed when a person does not have severe chest pain. […] The results show that when chest pain is not experienced or is mild, people tend to delay seeking help and do not recognise that it could be a cardiovascular event. […] Our study suggests a lower awareness and appropriate response to symptoms that do not include severe chest pain, she says. […] These results highlight the importance of educating the population about the various combinations of symptoms that could occur in a coronary infarction, which may or may not include chest pain, adds the researcher. […] Dr. Rocio Garcia-Retamero, professor of psychology at the University of Granada, highlights the gender gap in acute coronary syndrome, as various studies indicate that women experience chest pain less frequently than men, which could affect the correct recognition and treatment of the disease. […] This suggests that womens medical decisions may be influenced by factors other than disease recognition, which should be investigated in greater depth, says Garca Retamero.

• #30 A study identifies the signs of a heart attack that are least recognized by the population | Universidad de Granada

  https://www.ugr.es/en/about/news/signs-heart-attack-are-least-recognized-population

  Seeking medical care is more likely to be delayed when a person does not have severe chest pain. […] The results show that when chest pain is not experienced or is mild, people tend to delay seeking help and do not recognise that it could be a cardiovascular event. […] Our study suggests a lower awareness and appropriate response to symptoms that do not include severe chest pain, she says. […] These results highlight the importance of educating the population about the various combinations of symptoms that could occur in a coronary infarction, which may or may not include chest pain, adds the researcher. […] Dr. Rocio Garcia-Retamero, professor of psychology at the University of Granada, highlights the gender gap in acute coronary syndrome, as various studies indicate that women experience chest pain less frequently than men, which could affect the correct recognition and treatment of the disease. […] This suggests that womens medical decisions may be influenced by factors other than disease recognition, which should be investigated in greater depth, says Garca Retamero.

• #31 A study identifies the signs of a heart attack that are least recognized by the population | Universidad de Granada

  https://www.ugr.es/en/about/news/signs-heart-attack-are-least-recognized-population

  Seeking medical care is more likely to be delayed when a person does not have severe chest pain. […] The results show that when chest pain is not experienced or is mild, people tend to delay seeking help and do not recognise that it could be a cardiovascular event. […] Our study suggests a lower awareness and appropriate response to symptoms that do not include severe chest pain, she says. […] These results highlight the importance of educating the population about the various combinations of symptoms that could occur in a coronary infarction, which may or may not include chest pain, adds the researcher. […] Dr. Rocio Garcia-Retamero, professor of psychology at the University of Granada, highlights the gender gap in acute coronary syndrome, as various studies indicate that women experience chest pain less frequently than men, which could affect the correct recognition and treatment of the disease. […] This suggests that womens medical decisions may be influenced by factors other than disease recognition, which should be investigated in greater depth, says Garca Retamero.

• #32 Angina module 1: epidemiology – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/04/angina-module-1-epidemiology-2/

  William Heberden in 1772 was one of the first to describe angina pectoris. […] The prevalence of stable angina increases with age in both sexes. […] The patient-reported Health Survey for England, which asks individuals whether they have ever been given a diagnosis of angina by a health professional has a similar prevalence with angina having a 3% prevalence in all adults, and the highest burden in those aged over 75 years where the prevalence is 11%. […] In 2017, there were 1.7 million inpatient episodes related to all cardiovascular diseases, with 4.4% of these for angina pectoris in the UK. […] Men have a greater number of admissions related to CVD and angina. […] Mortality from CVD has dramatically declined since the 1960s. […] Angina is not benign and prognosis varies; recent-onset angina or worsening symptoms are cause for concern.

• #33 Angina Pectoris: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/150215-overview

  Approximately 9.8 million Americans are estimated to experience angina annually, with 500,000 new cases of angina occurring every year. […] In 2009, an estimated 785,000 Americans will have a new coronary attack, and about 470,000 will have a recurrent attack. Only 18% of coronary attacks are preceded by angina. An additional 195,000 silent first myocardial infarctions are estimated to occur each year. […] Angina pectoris is more often the presenting symptom of coronary artery disease in women than in men, with a female-to-male ratio of 1.7:1. It has an estimated prevalence of 4.6 million in women and 3.3 million in men. […] The prevalence of angina pectoris increases with age. Age is a strong independent risk factor for mortality. More than 150,000 Americans killed by CVD in 2005 were younger than 65 years. However, in 2005, 32% of deaths from cardiovascular disease occurred before the age of 75 years, which is well before the average life expectancy of 77.9 years.

• #34 Angina module 1: epidemiology – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/04/angina-module-1-epidemiology-2/

  William Heberden in 1772 was one of the first to describe angina pectoris. […] The prevalence of stable angina increases with age in both sexes. […] The patient-reported Health Survey for England, which asks individuals whether they have ever been given a diagnosis of angina by a health professional has a similar prevalence with angina having a 3% prevalence in all adults, and the highest burden in those aged over 75 years where the prevalence is 11%. […] In 2017, there were 1.7 million inpatient episodes related to all cardiovascular diseases, with 4.4% of these for angina pectoris in the UK. […] Men have a greater number of admissions related to CVD and angina. […] Mortality from CVD has dramatically declined since the 1960s. […] Angina is not benign and prognosis varies; recent-onset angina or worsening symptoms are cause for concern.

• #35 Coronary Risk Stratification of Chest Pain

  https://fpnotebook.com/CV/Exam/CrnryRskStrtfctnOfChstPn.htm

  Age 40 to 49 years: Male: 69% risk CAD if typical Chest Pain, 38% if Atypical Chest Pain, 25% nonanginal Chest Pain. Female: 37% risk CAD if typical Chest Pain, 14% if Atypical Chest Pain, 8% nonanginal Chest Pain. […] Age 50 to 69 years: Male: 77% risk CAD if typical Chest Pain, 49% if Atypical Chest Pain, 34% nonanginal Chest Pain. Female: 47% risk CAD if typical Chest Pain, 20% if Atypical Chest Pain, 12% nonanginal Chest Pain. […] Age 60 to 69 years: Male: 84% risk CAD if typical Chest Pain, 59% if Atypical Chest Pain, 44% nonanginal Chest Pain. Female: 58% risk CAD if typical Chest Pain, 28% if Atypical Chest Pain, 17% nonanginal Chest Pain. […] Age 70 to 79 years: Male: 89% risk CAD if typical Chest Pain, 69% if Atypical Chest Pain, 54% nonanginal Chest Pain. Female: 68% risk CAD if typical Chest Pain, 37% if Atypical Chest Pain, 24% nonanginal Chest Pain. […] Age 80 years: Male: 93% risk CAD if typical Chest Pain, 77% if Atypical Chest Pain, 65% nonanginal Chest Pain. Female: 76% risk CAD if typical Chest Pain, 47% if Atypical Chest Pain, 32% nonanginal Chest Pain.

• #36 Angina module 1: epidemiology – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/04/angina-module-1-epidemiology-2/

  There is a high burden of heart failure, hospital admissions and the requirement to undergo revascularisation. […] Those with angina compared to those with known coronary artery disease but no anginal symptoms have a poorer prognosis and a 19% increase in cardiovascular death, MI, or stroke. […] An estimated 2.3 million people are living with CHD in the UK. […] Within the UK, the incidence and prevalence of angina is not spread equally. […] CVD is heavily influenced by deprivation, with the most deprived having significantly higher rates of mortality compared to the least deprived. […] Each year cardiovascular disease (CVD) causes 3.9 million deaths in Europe and over 1.8 million deaths in the European Union (EU). […] South Asians have a higher risk for the development of CVD when compared to White and Black ethnicities.

• #37 Angina module 1: epidemiology – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/04/angina-module-1-epidemiology-2/

  There is a high burden of heart failure, hospital admissions and the requirement to undergo revascularisation. […] Those with angina compared to those with known coronary artery disease but no anginal symptoms have a poorer prognosis and a 19% increase in cardiovascular death, MI, or stroke. […] An estimated 2.3 million people are living with CHD in the UK. […] Within the UK, the incidence and prevalence of angina is not spread equally. […] CVD is heavily influenced by deprivation, with the most deprived having significantly higher rates of mortality compared to the least deprived. […] Each year cardiovascular disease (CVD) causes 3.9 million deaths in Europe and over 1.8 million deaths in the European Union (EU). […] South Asians have a higher risk for the development of CVD when compared to White and Black ethnicities.

• #38 Angina module 1: epidemiology – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/04/angina-module-1-epidemiology-2/

  These findings of excess risk in South Asians persist after adjusting for traditional CVD risk factors, which supports the role of ethnicity in the risk of developing CVD. […] Beyond the human cost, the total annual healthcare costs for CVD is 9 billion in the UK. […] CVD costs the European Union (EU) economy an estimated 210 billion yearly: 50% of this is direct healthcare costs with the residual being productivity loss and informal costs.

• #39 Chest Pain Differential Diagnosis – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/chest-pain-differential-diagnosis/

  As a prevalent medical complaint, chest pain differential diagnosis often is needed. There are numerous causes of chest pain, some of them life-threatening, and it accounts for 5% of all emergency hospital visits. Chest pain is reported in 7% to 24% of primary care visits, with the risk increasing after the age of 30. When a patient presents to a health care facility with chest pain, this chest pain should be triaged with a high priority level. An ECG should be administered to patients with suspected cardiac etiology of their chest pain, and the ECG results used to determine the necessary care plan. […] Chest pain can be life-threatening in some cases, but the prognosis will vary based on the causes of chest pain. For acute coronary syndrome patients, the prognosis remains poor, despite many modern advancements in diagnosis and treatments. In patients whose chest pain symptoms were caused by myocardial infarction, research estimates that, within a year, 23% of women and 18% of men aged 40 and over will have died. For patients with non-cardiac chest pain, prognosis is good, with less severe effect on mortality. However, ongoing non-cardiac chest pain can decrease a persons quality of life.

• #40 Chest pain epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Chest_pain_epidemiology_and_demographics

  According to a study conducted in Belgium, the prevalence of chest pain is approximately 2000-5000 per 100,000 individuals worldwide. […] The mortality rate of chest pain is approximately 3%. […] Patients with a myocardial infarction that presented without chest pain had a mortality rate of 23.3% compared with 9.3% in patients who had chest pain as a presentation. […] The incidence of patients presenting with chest pain increases with age; the median age being 53 years. […] Men are more likely to present with chest pain than women.

• #41 Chest pain epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Chest_pain_epidemiology_and_demographics

  According to a study conducted in Belgium, the prevalence of chest pain is approximately 2000-5000 per 100,000 individuals worldwide. […] The mortality rate of chest pain is approximately 3%. […] Patients with a myocardial infarction that presented without chest pain had a mortality rate of 23.3% compared with 9.3% in patients who had chest pain as a presentation. […] The incidence of patients presenting with chest pain increases with age; the median age being 53 years. […] Men are more likely to present with chest pain than women.

• #42 Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome – a systematic literature search | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-58

  The mean one-year total mortality rate among patients with NSCP in nine studies was 3.2% (inter-study range 1.4% to 8.1%), with the highest mortality among patients with pre-existing coronary heart disease (CHD). […] The mean one-year mortality rate among 'ACS/high-risk’ patients was 18.0% (inter-study range 14.0% to 19.9%) in four studies with available data. […] In six studies the mean one-year readmission rate for patients with NSCP was 17.5% (inter-study range 2.5% to 40%). […] Patients with NSCP represent a large, heterogeneous and important group. […] Due to co-existing CHD in nearly 40% of these patients, their prognosis is not necessarily benign. […] Although their average one-year mortality rate was almost six times lower than those with 'ACS/high-risk’, the subset with concomitant CHD had a relatively poor prognosis when compared with NSCP patients without evidence of CHD.

• #43 Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome – a systematic literature search | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-58

  The mean one-year total mortality rate among patients with NSCP in nine studies was 3.2% (inter-study range 1.4% to 8.1%), with the highest mortality among patients with pre-existing coronary heart disease (CHD). […] The mean one-year mortality rate among 'ACS/high-risk’ patients was 18.0% (inter-study range 14.0% to 19.9%) in four studies with available data. […] In six studies the mean one-year readmission rate for patients with NSCP was 17.5% (inter-study range 2.5% to 40%). […] Patients with NSCP represent a large, heterogeneous and important group. […] Due to co-existing CHD in nearly 40% of these patients, their prognosis is not necessarily benign. […] Although their average one-year mortality rate was almost six times lower than those with 'ACS/high-risk’, the subset with concomitant CHD had a relatively poor prognosis when compared with NSCP patients without evidence of CHD.

• #44 Chest Pain: Assessment and Treatment | Doctor

  https://patient.info/doctor/chest-pain-pro

  There is a 3% increased mortality rate in the year following consulting a GP regarding the onset of chest pain compared with a control group with no chest pain, the excess being primarily due to cardiovascular disease. […] Once a cardiac cause for chest pain is excluded, further investigation is often curtailed and many patients continue to experience undiagnosed chest pain, which carries significant psychological morbidity.

• #45 Noncardiac Chest Pain: Epidemiology, Natural Course and Pathogenesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2011.17.2.110

  Epidemiologic studies report a decrease in the prevalence of NCCP with increasing age. […] Many patients with NCCP report poor quality of life and admit taking cardiac medications despite lack of evidence for a cardiac cause. […] Consequently, the economic burden of the disease has been proposed to be very high, although studies evaluating the cost impact of NCCP on the healthcare system are very scarce. In 1 study, the healthcare cost for NCCP was estimated to be more than $315 million annually, primarily because of multiple clinic visits, emergency room visits, hospitalizations and prescription medications.

• #46 Angina module 1: epidemiology – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/04/angina-module-1-epidemiology-2/

  These findings of excess risk in South Asians persist after adjusting for traditional CVD risk factors, which supports the role of ethnicity in the risk of developing CVD. […] Beyond the human cost, the total annual healthcare costs for CVD is 9 billion in the UK. […] CVD costs the European Union (EU) economy an estimated 210 billion yearly: 50% of this is direct healthcare costs with the residual being productivity loss and informal costs.

• #47 Angina module 1: epidemiology – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/04/angina-module-1-epidemiology-2/

  These findings of excess risk in South Asians persist after adjusting for traditional CVD risk factors, which supports the role of ethnicity in the risk of developing CVD. […] Beyond the human cost, the total annual healthcare costs for CVD is 9 billion in the UK. […] CVD costs the European Union (EU) economy an estimated 210 billion yearly: 50% of this is direct healthcare costs with the residual being productivity loss and informal costs.

• #48 Characteristics of chest pain and its acute management in a low-middle income country: analysis of emergency department surveillance data from Pakistan | BMC Emergency Medicine | Full Text

  https://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-15-S2-S13

  Chest pain is one of the most frequent causes of emergency department (ED) visits in high-income countries. Little is known about chest pain patients presenting to EDs of low- and middle-income countries (LMICs). The objective of this study was to describe the characteristics of chest pain patients presenting to emergency departments (EDs) of Pakistan and to determine the utilization of ED resources in the management of chest pain patients and their outcomes. […] A total of 20,435 patients were admitted to the EDs with chest pain. The majority were males (M 60%, F 40%) and the mean age was 42 years (SD+/- 14). […] Chest pain is a common presenting complaint in EDs in Pakistan. The majority received an ECG and the use of diagnostic testing, such as cardiac enzymes, is quite uncommon. […] The burden of cardiovascular disease in low-and middle-income countries (LMICs) has gained increased attention, though population-based data on the prevalence of chest pain in developing countries is lacking.

• #49 Characteristics of chest pain and its acute management in a low-middle income country: analysis of emergency department surveillance data from Pakistan | BMC Emergency Medicine | Full Text

  https://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-15-S2-S13

  Examining the prevalence of chest pain – both angina (cardiac) and non-anginal (non-cardiac) – and its characteristics in LMICs is critical for developing targeted interventions for the management of chest pain patients in EDs and potentially stemming an epidemic of premature coronary deaths. […] During the Pak-NEDS study period, 20,435 patients were admitted to the EDs with chest pain as a major complaint. […] Less than 20% of all patients with chest pain were admitted to the hospital. This is a relatively low number of admission compared to findings in the US (35%) but comparable to findings in the UK (25%). […] The findings of this study showed a high burden of chest pain in Pakistan, with higher numbers in younger adults.

• #50 Awareness of Heart Attack Symptoms and Response Among Adults — United States, 2008, 2014, and 2017 | MMWR

  https://www.cdc.gov/mmwr/volumes/68/wr/mm6805a2.htm

  An estimated 750,000 heart attacks occur annually in the United States. Early intervention is critical in reducing morbidity and mortality. Improving public knowledge of the signs and symptoms of a heart attack can lead to improved survival and better outcomes. […] Analysis of National Health Interview Survey data for 2008, 2014, and 2017 found that knowledge of five common signs and symptoms of a heart attack and the appropriate emergency response increased significantly (from 40% to 50% and from 92% to 95%, respectively); however, sociodemographic disparities in knowledge persist. […] Identification of heart attack signs and symptoms by victims or bystanders, and taking immediate action by calling emergency services (9-1-1), are crucial to ensure timely receipt of emergency care and thereby improve the chance for survival.

• #51 Awareness of Heart Attack Symptoms and Response Among Adults — United States, 2008, 2014, and 2017 | MMWR

  https://www.cdc.gov/mmwr/volumes/68/wr/mm6805a2.htm

  The adjusted percentage of persons who knew all five common heart attack symptoms increased from 39.6% in 2008 to 50.0% in 2014 and to 50.2% in 2017. The adjusted percentage of adults who knew to call 9-1-1 if someone was having a heart attack increased from 91.8% in 2008 to 93.4% in 2014 and to 94.9% in 2017. […] Persistent disparities in awareness of heart attack symptoms were observed by demographic characteristics and cardiovascular risk group. […] Public health awareness initiatives and systematic integration of appropriate awareness and action in response to a perceived heart attack should be expanded across the health system continuum of care. […] Although this nationally representative survey indicates improvement in the percentage of adults who know the signs and symptoms of a heart attack and to call 9-1-1 if they witness someone having a heart attack, in 2017, approximately half of respondents (50.2%) knew all five common heart attack signs and symptoms, and disparities in awareness and response exist among all demographic groups and by CVD risk status.

• #52 Awareness of Heart Attack Symptoms and Response Among Adults — United States, 2008, 2014, and 2017 | MMWR

  https://www.cdc.gov/mmwr/volumes/68/wr/mm6805a2.htm

  The adjusted percentage of persons who knew all five common heart attack symptoms increased from 39.6% in 2008 to 50.0% in 2014 and to 50.2% in 2017. The adjusted percentage of adults who knew to call 9-1-1 if someone was having a heart attack increased from 91.8% in 2008 to 93.4% in 2014 and to 94.9% in 2017. […] Persistent disparities in awareness of heart attack symptoms were observed by demographic characteristics and cardiovascular risk group. […] Public health awareness initiatives and systematic integration of appropriate awareness and action in response to a perceived heart attack should be expanded across the health system continuum of care. […] Although this nationally representative survey indicates improvement in the percentage of adults who know the signs and symptoms of a heart attack and to call 9-1-1 if they witness someone having a heart attack, in 2017, approximately half of respondents (50.2%) knew all five common heart attack signs and symptoms, and disparities in awareness and response exist among all demographic groups and by CVD risk status.

• #53 Awareness of Heart Attack Symptoms and Response Among Adults — United States, 2008, 2014, and 2017 | MMWR

  https://www.cdc.gov/mmwr/volumes/68/wr/mm6805a2.htm

  The adjusted percentage of persons who knew all five common heart attack symptoms increased from 39.6% in 2008 to 50.0% in 2014 and to 50.2% in 2017. The adjusted percentage of adults who knew to call 9-1-1 if someone was having a heart attack increased from 91.8% in 2008 to 93.4% in 2014 and to 94.9% in 2017. […] Persistent disparities in awareness of heart attack symptoms were observed by demographic characteristics and cardiovascular risk group. […] Public health awareness initiatives and systematic integration of appropriate awareness and action in response to a perceived heart attack should be expanded across the health system continuum of care. […] Although this nationally representative survey indicates improvement in the percentage of adults who know the signs and symptoms of a heart attack and to call 9-1-1 if they witness someone having a heart attack, in 2017, approximately half of respondents (50.2%) knew all five common heart attack signs and symptoms, and disparities in awareness and response exist among all demographic groups and by CVD risk status.

• #54 Heart disease in Canada: Highlights from the Canadian Chronic Disease Surveillance System, 2017 – Canada.ca

  https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-canada-fact-sheet.html

  In Canada, heart disease is the second leading cause of death after cancer, and a leading cause of hospitalization. […] According to the most recent data from 2012/13, about 2.4 million (8.5%) Canadian adults aged 20 years and older live with diagnosed ischemic heart disease, including 578,000 (2.1%) with a history of a heart attack. […] About 158,700 (6.1 per 1,000) Canadian adults aged 20 years and older received a new diagnosis of ischemic heart disease. Specifically, about 63,200 (2.3 per 1,000) adults had a first heart attack. […] The prevalence and incidence of diagnosed ischemic heart disease and heart failure are consistently higher among men than women. […] On average, men are about 2 times more likely than women to have a first acute myocardial infarction. […] The prevalence of diagnosed ischemic heart disease increases as people age and is higher among men than women in all age groups. […] The data used in this publication are from the Canadian Chronic Disease Surveillance System (CCDSS), a collaborative network of provincial and territorial chronic disease surveillance systems, led by the Public Health Agency of Canada (PHAC).

• #55

  https://www.nice.org.uk/consultations/623/2/overview-of-2019-surveillance-methods

  NICE’s surveillance team checked whether recommendations in chest pain of recent onset: assessment and diagnosis (NICE guideline CG95) remain up to date. […] We searched for new evidence related to specific parts of the guideline. These areas were suggested by topic experts as the key areas to focus on for this surveillance review. […] We found 7 studies in a search for studies published between 10 May 2016 and 24 April 2019. […] We found 4 studies in a search for studies published between 10 May 2016 and 24 April 2019. […] We found 4 studies in a search for studies published between 21 May 2015 and 18 April 2019. […] From all sources, we considered 34 studies to be relevant to the guideline. […] We checked for relevant ongoing research; of the ongoing studies identified, 6 studies were assessed as having the potential to change recommendations.

• #56

  https://www.nice.org.uk/consultations/623/2/overview-of-2019-surveillance-methods

  The majority of topic experts did not think the guideline needed to be updated. […] Topic expert feedback in this surveillance review emphasised difficulties in implementation of the recommendations from the 2016 guideline update on the use of CCTA in stable chest pain. […] There is no evidence from this surveillance to suggest that CCTA should no longer be recommended as a diagnostic tool. […] The use of high-sensitivity troponin tests for early rule out of myocardial infarction, which is also within the scope of this guideline, is another technology being supported by the Accelerated Access Collaborative. […] We do not consider there to be potential impact on recommendations in the guideline.

• #57

  https://www.nice.org.uk/consultations/623/2/summary-of-evidence-from-surveillance

  Studies identified in searches are summarised from the information presented in their abstracts. […] This section of the guideline covers the assessment and diagnosis of people with recent acute chest pain or discomfort, suspected to be caused by an acute coronary syndrome (ACS). The term ACS covers a range of conditions including unstable angina, ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). […] Recommendation 1.2.1.13 advises that, if an ACS is not suspected, other causes of chest pain be considered, some of which may be life-threatening. […] When diagnosing MI, use the universal definition of myocardial infarction. This is the detection of rise and/or fall of cardiac biomarkers values with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischaemia, new or presumed new significant ST-segment T wave (STT) changes or new left bundle branch block (LBBB), development of pathological Q waves in the ECG, imaging evidence of new loss of viable myocardium or new regional wall motion abnormality, identification of an intracoronary thrombus by angiography. […] The guideline addresses assessment and diagnosis irrespective of setting, because people present in different ways. […] New evidence is unlikely to change guideline recommendations.

• #58

  https://www.nice.org.uk/consultations/623/2/overview-of-2019-surveillance-methods

  The majority of topic experts did not think the guideline needed to be updated. […] Topic expert feedback in this surveillance review emphasised difficulties in implementation of the recommendations from the 2016 guideline update on the use of CCTA in stable chest pain. […] There is no evidence from this surveillance to suggest that CCTA should no longer be recommended as a diagnostic tool. […] The use of high-sensitivity troponin tests for early rule out of myocardial infarction, which is also within the scope of this guideline, is another technology being supported by the Accelerated Access Collaborative. […] We do not consider there to be potential impact on recommendations in the guideline.

• #59 Approach to the adult with nontraumatic chest pain in the emergency department – UpToDate

  https://www.uptodate.com/contents/evaluation-of-the-adult-with-chest-pain-in-the-emergency-department

  Chest pain is the second most common complaint in adult emergency departments (ED) patients in the United States (US), accounting for 6 to 7 percent (between 7 and 8 million) of annual visits. Most visits result in a diagnosis of noncardiac chest pain, and approximately half do not have a specific cause identified and thus are considered to have nonspecific chest pain. Approximately 6 percent are ultimately diagnosed with a life-threatening condition, which is overwhelmingly (>90 percent) acute coronary syndrome. The risk of a life-threatening diagnosis increases with advancing age. […] Clinicians in the ED focus on the immediate recognition and exclusion of life-threatening causes of chest pain. Patients with life-threatening etiologies for chest pain may appear deceptively well, manifesting neither vital sign nor physical examination abnormalities.

• #60 Approach to the adult with nontraumatic chest pain in the emergency department – UpToDate

  https://www.uptodate.com/contents/evaluation-of-the-adult-with-chest-pain-in-the-emergency-department

  Chest pain is the second most common complaint in adult emergency departments (ED) patients in the United States (US), accounting for 6 to 7 percent (between 7 and 8 million) of annual visits. Most visits result in a diagnosis of noncardiac chest pain, and approximately half do not have a specific cause identified and thus are considered to have nonspecific chest pain. Approximately 6 percent are ultimately diagnosed with a life-threatening condition, which is overwhelmingly (>90 percent) acute coronary syndrome. The risk of a life-threatening diagnosis increases with advancing age. […] Clinicians in the ED focus on the immediate recognition and exclusion of life-threatening causes of chest pain. Patients with life-threatening etiologies for chest pain may appear deceptively well, manifesting neither vital sign nor physical examination abnormalities.

• #61 Approach to the adult with nontraumatic chest pain in the emergency department – UpToDate

  https://www.uptodate.com/contents/evaluation-of-the-adult-with-chest-pain-in-the-emergency-department

  Chest pain is the second most common complaint in adult emergency departments (ED) patients in the United States (US), accounting for 6 to 7 percent (between 7 and 8 million) of annual visits. Most visits result in a diagnosis of noncardiac chest pain, and approximately half do not have a specific cause identified and thus are considered to have nonspecific chest pain. Approximately 6 percent are ultimately diagnosed with a life-threatening condition, which is overwhelmingly (>90 percent) acute coronary syndrome. The risk of a life-threatening diagnosis increases with advancing age. […] Clinicians in the ED focus on the immediate recognition and exclusion of life-threatening causes of chest pain. Patients with life-threatening etiologies for chest pain may appear deceptively well, manifesting neither vital sign nor physical examination abnormalities.

• #62 Approach to the adult with nontraumatic chest pain in the emergency department – UpToDate

  https://www.uptodate.com/contents/evaluation-of-the-adult-with-chest-pain-in-the-emergency-department

  Chest pain is the second most common complaint in adult emergency departments (ED) patients in the United States (US), accounting for 6 to 7 percent (between 7 and 8 million) of annual visits. Most visits result in a diagnosis of noncardiac chest pain, and approximately half do not have a specific cause identified and thus are considered to have nonspecific chest pain. Approximately 6 percent are ultimately diagnosed with a life-threatening condition, which is overwhelmingly (>90 percent) acute coronary syndrome. The risk of a life-threatening diagnosis increases with advancing age. […] Clinicians in the ED focus on the immediate recognition and exclusion of life-threatening causes of chest pain. Patients with life-threatening etiologies for chest pain may appear deceptively well, manifesting neither vital sign nor physical examination abnormalities.

• #63 Noncardiac Chest Pain: Epidemiology, Natural Course and Pathogenesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2011.17.2.110

  Noncardiac chest pain is a prevalent disorder resulting in high healthcare resource utilization and significant work absenteeism. […] Information about the epidemiology of NCCP in the United States and around the world is relatively limited. Presently, chest pain is the second most common presentation to hospital emergency departments; however, only 25% of individuals who experience chest pain actually present to a hospital. […] The mean annual prevalence of NCCP in 6 population-based studies was approximately 25%. […] A population-based survey in the United States assessed the prevalence of GERD in Olmsted County, Minnesota and reported an overall NCCP prevalence of 23%. […] A nationwide population-based study from South America found that the annual prevalence of NCCP was 23.5% and that NCCP has been equally reported by both sexes.

• #64 Noncardiac Chest Pain: Epidemiology, Natural Course and Pathogenesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2011.17.2.110

  Epidemiologic studies report a decrease in the prevalence of NCCP with increasing age. […] Many patients with NCCP report poor quality of life and admit taking cardiac medications despite lack of evidence for a cardiac cause. […] Consequently, the economic burden of the disease has been proposed to be very high, although studies evaluating the cost impact of NCCP on the healthcare system are very scarce. In 1 study, the healthcare cost for NCCP was estimated to be more than $315 million annually, primarily because of multiple clinic visits, emergency room visits, hospitalizations and prescription medications.

• #65 Noncardiac Chest Pain: Epidemiology, Natural Course and Pathogenesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2011.17.2.110

  Epidemiologic studies report a decrease in the prevalence of NCCP with increasing age. […] Many patients with NCCP report poor quality of life and admit taking cardiac medications despite lack of evidence for a cardiac cause. […] Consequently, the economic burden of the disease has been proposed to be very high, although studies evaluating the cost impact of NCCP on the healthcare system are very scarce. In 1 study, the healthcare cost for NCCP was estimated to be more than $315 million annually, primarily because of multiple clinic visits, emergency room visits, hospitalizations and prescription medications.

• #66 Chest Pain: Assessment and Treatment | Doctor

  https://patient.info/doctor/chest-pain-pro

  There is a 3% increased mortality rate in the year following consulting a GP regarding the onset of chest pain compared with a control group with no chest pain, the excess being primarily due to cardiovascular disease. […] Once a cardiac cause for chest pain is excluded, further investigation is often curtailed and many patients continue to experience undiagnosed chest pain, which carries significant psychological morbidity.

• #67 Prognosis of undiagnosed chest pain: linked electronic health record cohort study | The BMJ

  https://www.bmj.com/content/357/bmj.j1194

  Objective To ascertain long term cardiovascular outcomes in patients whose chest pain remained undiagnosed six months after first presentation. […] Most patients with first onset chest pain do not have a diagnosis recorded at presentation or in the subsequent six months, including those who undergo cardiac investigations. These patients have an increased risk of cardiovascular events for at least five years. […] Cardiovascular disease will be diagnosed in 2-10% of patients in the unattributed group within 12 months, most within 6-12 weeks of that first presentation. […] Patients in the general population who report chest pain and those attending specialist chest pain clinics who are told that they do not have a cardiac cause of their chest pain have a higher future incidence of fatal and non-fatal cardiovascular disease than pain-free populations.

• #68 Prognosis of undiagnosed chest pain: linked electronic health record cohort study | The BMJ

  https://www.bmj.com/content/357/bmj.j1194

  Objective To ascertain long term cardiovascular outcomes in patients whose chest pain remained undiagnosed six months after first presentation. […] Most patients with first onset chest pain do not have a diagnosis recorded at presentation or in the subsequent six months, including those who undergo cardiac investigations. These patients have an increased risk of cardiovascular events for at least five years. […] Cardiovascular disease will be diagnosed in 2-10% of patients in the unattributed group within 12 months, most within 6-12 weeks of that first presentation. […] Patients in the general population who report chest pain and those attending specialist chest pain clinics who are told that they do not have a cardiac cause of their chest pain have a higher future incidence of fatal and non-fatal cardiovascular disease than pain-free populations.

• #69 Prognosis of undiagnosed chest pain: linked electronic health record cohort study | The BMJ

  https://www.bmj.com/content/357/bmj.j1194

  Risk of cardiovascular events did not change over time. […] The risk of cardiovascular disease in the long term was higher in patients with a diagnostic investigation in the first six months than in those without, regardless of their initial diagnosis. […] The large group of patients with undiagnosed chest pain in primary care generally do not undergo diagnostic testing but have an increased risk of fatal and non-fatal cardiovascular events for at least five years. More needs to be done to improve the assessment of chest pain in this group and reduce the cardiovascular risk of such patients.

• #70 Prognosis of undiagnosed chest pain: linked electronic health record cohort study | The BMJ

  https://www.bmj.com/content/357/bmj.j1194

  Risk of cardiovascular events did not change over time. […] The risk of cardiovascular disease in the long term was higher in patients with a diagnostic investigation in the first six months than in those without, regardless of their initial diagnosis. […] The large group of patients with undiagnosed chest pain in primary care generally do not undergo diagnostic testing but have an increased risk of fatal and non-fatal cardiovascular events for at least five years. More needs to be done to improve the assessment of chest pain in this group and reduce the cardiovascular risk of such patients.

• #71 Prognosis of undiagnosed chest pain: linked electronic health record cohort study | The BMJ

  https://www.bmj.com/content/357/bmj.j1194

  Risk of cardiovascular events did not change over time. […] The risk of cardiovascular disease in the long term was higher in patients with a diagnostic investigation in the first six months than in those without, regardless of their initial diagnosis. […] The large group of patients with undiagnosed chest pain in primary care generally do not undergo diagnostic testing but have an increased risk of fatal and non-fatal cardiovascular events for at least five years. More needs to be done to improve the assessment of chest pain in this group and reduce the cardiovascular risk of such patients.

• #72 Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome – a systematic literature search | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-58

  The mean one-year total mortality rate among patients with NSCP in nine studies was 3.2% (inter-study range 1.4% to 8.1%), with the highest mortality among patients with pre-existing coronary heart disease (CHD). […] The mean one-year mortality rate among 'ACS/high-risk’ patients was 18.0% (inter-study range 14.0% to 19.9%) in four studies with available data. […] In six studies the mean one-year readmission rate for patients with NSCP was 17.5% (inter-study range 2.5% to 40%). […] Patients with NSCP represent a large, heterogeneous and important group. […] Due to co-existing CHD in nearly 40% of these patients, their prognosis is not necessarily benign. […] Although their average one-year mortality rate was almost six times lower than those with 'ACS/high-risk’, the subset with concomitant CHD had a relatively poor prognosis when compared with NSCP patients without evidence of CHD.

• #73 Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome – a systematic literature search | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-58

  The objective of this review is to obtain information regarding the prevalence and prognosis of NSCP in comparison with patients with ACS. […] In total, 11,008 (44%) patients were categorized as having NSCP according to the criteria applied in the present review. […] The prevalence of NSCP ranged between 18% and 82% in the studies selected. […] In six studies the mean one-year readmission rate for patients with NSCP was 17.5% (inter-study range 2.5% to 40%). […] In the NSCP group, the mean one-year mortality rate in nine studies was 3.2% (range 1.4 to 8.1%). […] For patients in the 'ACS/high-risk’ groups the mean one-year mortality rate was 18.0% (inter-study range 14% to 19.9%) in the four studies where this was reported. […] The introduction of more sensitive assays for troponins combined with new sensitive markers, such as Copeptin and high sensitive Troponin T, will probably convert a number of non-ACS patients into patients with NSTEMI. […] The remaining patients may be offered a comprehensive non-cardiac evaluation of their symptoms in order to explore possible causes of their pain.

• #74 Chest Pain in Repeated Emergency Department Visitors

  https://www.scientificarchives.com/article/Chest-Pain-in-Repeated-Emergency-Department-Visitors

  Chest pain is responsible for up to 8% of all emergency department (ED) visits. It is a symptom of potentially harmful diseases including acute myocardial infarction (AMI). The aim of this study was to evaluate the prevalence of AMI and other causes of chest pain in repeated ED visitors with chest pain. […] In general, in 15 to 25% of patients with chest pain, acute myocardial infarction (AMI) is the underlying cause. […] The overall prevalence of AMI was 7.4%, but no AMI occurred in repeated ED visitors with chest pain. The overall risk of having an AMI after the index ED visit was 2.2% in the entire study population whereas it was 0% for the repeated ED visitors. […] In our study, non-cardiac disorders were the cause for chest pain in more than 60% of all ED visits. Our analysis showed that chest pain was caused in a third of all repeated ED visits by a psychosomatic origin. […] Nevertheless, repeated ED visitors with chest pain must be seriously investigated each time at presentation and cardiac causes need to be excluded.

• #75 Chest Pain in Repeated Emergency Department Visitors

  https://www.scientificarchives.com/article/Chest-Pain-in-Repeated-Emergency-Department-Visitors

  Chest pain is responsible for up to 8% of all emergency department (ED) visits. It is a symptom of potentially harmful diseases including acute myocardial infarction (AMI). The aim of this study was to evaluate the prevalence of AMI and other causes of chest pain in repeated ED visitors with chest pain. […] In general, in 15 to 25% of patients with chest pain, acute myocardial infarction (AMI) is the underlying cause. […] The overall prevalence of AMI was 7.4%, but no AMI occurred in repeated ED visitors with chest pain. The overall risk of having an AMI after the index ED visit was 2.2% in the entire study population whereas it was 0% for the repeated ED visitors. […] In our study, non-cardiac disorders were the cause for chest pain in more than 60% of all ED visits. Our analysis showed that chest pain was caused in a third of all repeated ED visits by a psychosomatic origin. […] Nevertheless, repeated ED visitors with chest pain must be seriously investigated each time at presentation and cardiac causes need to be excluded.

• #76 Chest Pain in Repeated Emergency Department Visitors

  https://www.scientificarchives.com/article/Chest-Pain-in-Repeated-Emergency-Department-Visitors

  Chest pain is responsible for up to 8% of all emergency department (ED) visits. It is a symptom of potentially harmful diseases including acute myocardial infarction (AMI). The aim of this study was to evaluate the prevalence of AMI and other causes of chest pain in repeated ED visitors with chest pain. […] In general, in 15 to 25% of patients with chest pain, acute myocardial infarction (AMI) is the underlying cause. […] The overall prevalence of AMI was 7.4%, but no AMI occurred in repeated ED visitors with chest pain. The overall risk of having an AMI after the index ED visit was 2.2% in the entire study population whereas it was 0% for the repeated ED visitors. […] In our study, non-cardiac disorders were the cause for chest pain in more than 60% of all ED visits. Our analysis showed that chest pain was caused in a third of all repeated ED visits by a psychosomatic origin. […] Nevertheless, repeated ED visitors with chest pain must be seriously investigated each time at presentation and cardiac causes need to be excluded.

• #77 Chest Pain in Repeated Emergency Department Visitors

  https://www.scientificarchives.com/article/Chest-Pain-in-Repeated-Emergency-Department-Visitors

  Chest pain is responsible for up to 8% of all emergency department (ED) visits. It is a symptom of potentially harmful diseases including acute myocardial infarction (AMI). The aim of this study was to evaluate the prevalence of AMI and other causes of chest pain in repeated ED visitors with chest pain. […] In general, in 15 to 25% of patients with chest pain, acute myocardial infarction (AMI) is the underlying cause. […] The overall prevalence of AMI was 7.4%, but no AMI occurred in repeated ED visitors with chest pain. The overall risk of having an AMI after the index ED visit was 2.2% in the entire study population whereas it was 0% for the repeated ED visitors. […] In our study, non-cardiac disorders were the cause for chest pain in more than 60% of all ED visits. Our analysis showed that chest pain was caused in a third of all repeated ED visits by a psychosomatic origin. […] Nevertheless, repeated ED visitors with chest pain must be seriously investigated each time at presentation and cardiac causes need to be excluded.

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