Introduction
Chest pain stands out as a critical symptom for patients initially presenting with ischaemic heart disease (IHD). Despite its significance, the frequency of IHD diagnosis among patients seeking general practitioner (GP) consultations for chest pain remains an area requiring deeper understanding. This study aims to evaluate the occurrence of IHD in individuals consulting their GP due to chest pain, analyze the outcomes of bicycle exercise tests in these patients, and provide an estimate of IHD incidence within the broader population.
Study Design and Methods
This prospective descriptive study was conducted across three primary health centers in southeastern Sweden. Participants included patients aged 20 to 79 years without a pre-existing IHD diagnosis, who consulted for a new episode of chest pain. Patients were systematically enrolled, and their outcomes were categorized into IHD, possible IHD, or not IHD. This classification was based on data collected from postal questionnaires, bicycle exercise test results, and hospital records. Retrospective analysis of hospital registry data for patients diagnosed with IHD was also performed to complement the primary care findings and estimate population incidence.
Key Findings
Among 38,075 GP consultations, 577 (1.5%) were related to chest pain. IHD was definitively diagnosed in 41 patients, representing 8% of those presenting with chest pain. In a significant majority, 441 patients (83%), IHD was excluded as a diagnosis. However, for 50 patients (9%), the diagnosis remained uncertain, indicating a need for further investigation. Bicycle exercise tests proved diagnostically valuable, yielding conclusive results in 77% of cases, with normal test results being the most common finding. By integrating data from both primary health centers and hospital records, the estimated annual incidence of IHD was 6.5 new diagnoses per 1000 residents within the 20 to 79 year age group.
Conclusion
The frequency of new chest pain episodes leading patients to consult their GP was observed to be low. Notably, IHD was diagnosed in 8% of these patients. A further 9% of patients with chest pain required additional investigation or clinical evaluation to clarify their diagnosis. These findings underscore the importance of effective diagnostic strategies in primary care for patients presenting with chest pain to ensure timely and accurate identification of IHD and appropriate patient management.
