Abstract 13901: Unexplained Chest Pain Linked With High Rates of Recidivism and Costs - A Prospective Gender Specific Analysis
Context: Recidivism for non-specific or unexplained chest pain (UCP) is common in patients with and without coronary artery disease (CAD).
Objectives: To compare chest pain recidivism (a) between patients with UCP and CAD and (b) by gender and estimate the annual cost of UCP.
Methods: In a retrospective cohort study, a Veteran Affairs (VA) administrative and clinical database of Veterans deployed to Iraq or Afghanistan was queried for first disease specific ICD-9 code to form two cohorts: UCP and CAD. Patients were followed between 09/2001-09/2010 for the first return and total return visits for UCP, cardiac pain (ACS or angina) or all-cause death. Time to first return and cumulative returns were analyzed using Cox regression and negative binomial models and adjusted for age, gender, race, marital status, and cardiac risk factors (hypertension, hyperlipidemia, diabetes, smoking and obesity). Direct total costs included inpatient, outpatient and fee-basis costs.
Results: Of 749,036 patients, 20,521 had UCP and 5,303 had CAD and were followed on average 2.2 years. UCP patients and women were younger and had a lower burden of cardiac risk factors compared to the CAD cohort and men respectively (p<.01). UCP patients were more likely to return earlier with any chest pain (aHR=1.76; 95% CI 1.65-1.88) and for unexplained chest pain than CAD patients (aHR: 1.89; 95% CI 1.77-2.01). Per 100 patients, the 1-year cumulative returns were 37 visits for CAD and 45 visits for UCP cohort (aRate Ratio=1.54; 95% CI 1.43-1.64). No difference was found by gender in time to first return for chest pain (aHR: 0.99; 95% CI 0.91-1.06) or in total return visits for UCP (aRR:1.07; 95% CI 0.98-1.19). The average annual costs for chest pain were $69,009 for CAD and $57,336 for UCP patients (geometric mean ratio =1.25; 95% CI 1.18-1.32).
Conclusion: Chest pain recidivism occurs earlier and more frequently in patients with UCP than CAD and is associated with high, unrecognized cumulative costs to the health care system. Further work is required to better understand and manage unexplained chest pain syndrome.
- © 2013 by American Heart Association, Inc.