Chest pain in family practice. Diagnosis and long-term outcome in a community setting

Abstract

Objective: To describe diagnostic distribution and outcome of chest pain among patients attending an urban family practice.

Design: Retrospective, descriptive chart review.

Setting: Primary care practice.

Participants: All patients contacts for chest pain at Fossvogur Health Centre in the years 1989 and 1990 (193 contacts with 189 patients) were examined. One patient died before follow up and two could not be reached for follow up; they were excluded from the study. Of the 190 contacts and 186 patients studied, one patient who had two contacts with the clinic died during the study.

Main outcome measures: Age and sex distribution, physical examination, investigations, diagnosis, and treatment; well-being of every patient was checked 3 to 4 years after initial contact. We asked about evolution of symptoms and looked for possible misdiagnosis.

Results: Musculoskeletal pain was diagnosed in 48.9% of contacts, heart diseases in 17.9% and 9.5% had undiagnosed chest pain. The history was the main diagnostic tool for patients with musculoskeletal diseases, while patients with heart diseases were examined more carefully and underwent more diagnostic procedures. Follow up showed that no serious disease had been missed in spite of restrictive use of laboratory investigations.

Conclusions: The working methods of family doctors who examined patients with chest pain in this health centre can differentiate between patients with serious diseases and those with benign conditions.