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Patients with unexplained chest pain at increased risk of heart attack later in life

NIHR supported researchers have found that people with unattributed chest pain were at a 15% increased risk of a heart attack in the first year after visiting their GP, with a continued increased risk over the next 10 years.

Up to one million adults in the UK see their GP because of chest pain each year. Many of these people will not receive a diagnosis, and their records will state that they have unattributed chest pain.

Heart related chest pain can be difficult for GPs to diagnose because the symptoms may be put down to other commonly associated conditions, such as muscular problems or anxiety, and blockages to the smallest blood vessels supplying the heart are too small to see with traditional tests.

Researchers supported by NIHR Applied Research Collaboration West Midlands analysed GP, hospital, and death data from between 2002-2018 of over half a million adults with no prior history of chest pain or cardiovascular disease. They compared cardiovascular outcomes, such as heart attack and stroke, between people with unattributed chest pain and those with chest pain attributed to a non-cardiovascular reason, such as a musculoskeletal condition.

This analysis found that patients with unattributed chest pain were at a 15% increased risk of a heart attack in the first year, with a continued increased risk over the 10 years following their initial appointment.

The study, published in the Journal of the American Heart Association, also found that lipid-lowering medication was only offered to 30% of patients with key risk factors for cardiovascular disease, meaning that many patients at highest risk may be missing out on vital preventative treatments.

The researchers suggest improved targeting of patients with unexplained chest pain and a high-risk profile could reduce future heart attacks. Using non-invasive investigation techniques, such as heart x-rays, in those with unexplained chest pain and a high-risk profile may help to identify early signs of a heart attack.

Professor Kelvin Jordan, project lead and Professor of Biostatistics at Keele University’s School of Medicine, said: “Chest pain is a common reason to go and see a GP. There are many potential causes of this pain and often patients do not receive a specific diagnosis. Our study suggests that these patients are more likely to have a future heart attack than patients given a non-cardiac reason for their chest pain.

“We now aim to identify common factors in patients who did go on to suffer a heart attack. This information will help GPs identify those patients with unexplained chest pain who are most at risk so they can be offered medication or further support at an earlier stage to reduce likelihood of a future heart attack.”

Professor Melanie Davies, Director of the NIHR Leicester Biomedical Research Centre, said: "This research points to a potential new route to identifying people with an increased risk of having a heart attack, so they can be targeted with bespoke prevention advice - collaborative research like this is crucial for NIHR's aim of delivering the best research for improved health for everyone."

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