Biography
Biography: Grace M. Egeland
Abstract
Prognosis of unspecified chest pain is important given the high frequency of chest pain leading to emergency medical care. The 1-yr prognosis of patients (aged 20-89 years) discharged with a primary diagnosis of unspecified chest pain (ICD-10, R072-R074) in 2010-2012 was evaluated using Norwegian health care administrative data sources. For evaluation of incident events, patients with a prior 2-yr history of chest pain or cardiovascular disease (CVD) were excluded. Nelson-Aalen cumulative hazards of incident ischemic heart disease (IHD) and monthly hazards of mortality following discharge were evaluated. Mortality was also compared to the general population by standard mortality ratios (SMR). There were 59,569 patients identified; the majorities were referred to hospital or outpatient clinics by community emergency medical centers. The hazards of mortality and the percent of deaths attributed to cardiovascular disease (CVD) were highest within the first 2 months post discharge. Cumulative hazards of IHD for men aged 45-64 and 65-74 years was 12% and 20%, and for women 6% and 10%, respectively by age group. Men and women under 65 yrs. of age had significantly higher non-CVD mortality than expected: SMR (95% CI) for men > 65 yrs. of age was 1.35 (1.2-1.6); for men < 65 yrs. of age was 1.53 (1.21-1.91); and for women < 65 yrs. of age the SMR was 1.54 (1.17-1.98). The prognostic data indicates that patients discharged with unspecified chest pain are an at-risk group in terms of early post-discharge mortality, incident IHD, and non-CVD mortality.