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Chest pain and ischaemic heart disease in primary care
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
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2003 (English)In: British Journal of General Practice, ISSN 0960-1643 (print) 1478-5242 (online), Vol. 53, no 490, 378-382 p.Article in journal (Refereed) Published
Abstract [en]

Background: Chest pain is the main symptom of first presentation with ischaemic heart disease (IHD). Little is known about the incidence of IHD among patients consulting the general practitioner (GP) for chest pain.

Aims: To estimate the occurrence of IHD among patients consulting for chest pain, to study the results of the bicycle exercise test, and to estimate the incidence of IHD in the population.

Design of study: Prospective descriptive study.

Setting: Three primary health centres in south-eastern Sweden

Method: All patients without a current IHD diagnosis, aged 20 to 79 years, and consulting for a new episode of chest pain, were included consecutively. The outcome was classified as IHD, possible IHD or not IHD, according to the results of a postal questionnaire, an exercise test or hospital care. Data from the hospital registry on patients with a diagnosis of IHD were analysed retrospectively.

Results: Out of 38 075 GP consultations, 577 (1.5%) were for chest pain. IHD was diagnosed in 41 (8%) of the chest pain patients, in 41 (83%) the diagnosis was excluded, and in 50 (9%) the diagnosis was judged as being uncertain. Even though the diagnostic criteria were strict, the exercise tests led to a diagnostic conclusion in 77% of the cases, most frequently a normal test result. Combining data from primary and hospital care, the yearly incidence of IHD was 6.5 diagnosed per 1000 inhabitants (aged 20 to 79 years old).

Conclusion: The incidence of a new episode of chest pain bringing the patient to the GP was low. Eight per cent of the patients received an IHD diagnosis, and in 9% further investigation or clinical assessment is needed.

Place, publisher, year, edition, pages
2003. Vol. 53, no 490, 378-382 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13082OAI: diva2:17793
Available from: 2008-03-25 Created: 2008-03-25 Last updated: 2009-08-20
In thesis
1. Chest pain and ischemic heart disease: Diagnosis and management in primary health care
Open this publication in new window or tab >>Chest pain and ischemic heart disease: Diagnosis and management in primary health care
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims. In patients consulting for chest pain, it is of great importance to evaluate the possibility of ischemic heart disease (IHD). The aims in this thesis were to investigate the accuracy of the general practitioners’ clinical assessments and the applicability of exercise testing and myocardial perfusion scintigraphy (MPS) in patients consulting for chest pain in primary care.

Statins are known to prevent IHD. A further aim was therefore to investigate if a relation could be detected on a population basis between the use of statins and the morbidity of acute myocardial infarction (AMI).

Methods. All patients from 20 to 79 years, consulting for a new episode of chest pain in three primary health care centres, were included during almost two years from 1998 to 2000. The patients were managed according to the clinical evaluation. The presence of IHD was excluded either by clinical examination only, or if stable IHD was in question, by exercise testing and if the exercise test was inconclusive by an additional MPS. If unstable IHD or myocardial infarction was suspected, referral for emergency hospital examination was made.

Correlations between statin sales and the morbidity of AMI in Sweden’s municipalities were analysed in an ecological, register based study. Adjustment was made for sales of antidiabetics, socio-economic deprivation indexes and geographic coordinates.

Results. Consultations for chest pain represented 1.5% of all consultations in the ages 20 to 79 and were made by 554 patients. In 281 patients IHD was excluded by clinical examination only. In 208 patients stable IHD and in 65 unstable IHD was in question. Four patients (1.4%) evaluated as not having IHD, were diagnosed with angina pectoris or AMI within three months. Exercise testing was performed in 191 patients and revealed no IHD in 134 and IHD in 14 patients. In 43 patients the exercise test results were equivocal. Thirty-nine of these patients underwent MPS, which showed no IHD in 20 and IHD in 19 of the patients.

In a follow up almost six years later, neither mortality rate nor prevalence of IHD differed significantly between the 384 study patients evaluated not to have IHD and the population controls.

Statin sales and AMI-incidence or mortality showed no strong associations from 1998 to 2002.


·Primary care is an appropriate level of care for ruling out IHD as the cause of chest pain, with sufficient safety and for diagnostics of stable IHD.

·Exercise testing and myocardial perfusion scintigraphy are useful procedures when investigating chest pain patients in primary care.

·The results indicate that preventive measures other than increased statin treatment should be considered to further decrease AMI-morbidity.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2008. 253 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1039
Chest pain, ischemic heart disease, primary health care, diagnosis, lipid lowering drugs
National Category
Clinical Science
urn:nbn:se:liu:diva-11390 (URN)978-91-7393-987-4 (ISBN)
Public defence
2008-04-11, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Available from: 2008-03-25 Created: 2008-03-25 Last updated: 2009-08-21

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Nilsson, StaffanEngblom, DavidMölstad, SigvardÅkerlind, IngemarNylander, Eva
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Department of Medicine and Health SciencesFaculty of Health SciencesEast County Primary Health CareCell BiologyHealth and SocietyUnit of Research and Development in Local Health Care, County of ÖstergötlandClinical Physiology Department of Clinical Physiology
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