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2015 ; 16
(ä): 88
Nephropedia Template TP
gab.com Text
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English Wikipedia
Chest pain syndromes are associated with high rates of recidivism and costs in
young United States Veterans
#MMPMID26202799
Safdar B
; Dziura J
; Bathulapalli H
; Leslie DL
; Skanderson M
; Brandt C
; Haskell SG
BMC Fam Pract
2015[Jul]; 16
(ä): 88
PMID26202799
show ga
BACKGROUND: Recurrent chest pain is common in patients with and without coronary
artery disease. The prevalence and burden of these symptoms on healthcare is
unknown. OBJECTIVES: To compare chest pain return visits (recidivism) in patients
with unexplained chest pain (UCP) against reference group of patients with
coronary artery disease (CAD) and estimate the annual cost of recurrent chest
pain. METHODS: In a retrospective cohort study, a Veteran Affairs (VA)
administrative and clinical database of Veterans who were deployed to or served
in support of the wars in Iraq or Afghanistan was queried for first disease
specific ICD-9 code to form two cohorts (UCP or CAD). Patients were followed
between 09/2001-09/2010 for the first and cumulative return visits for UCP or
cardiac pain (ACS or angina) to clinic, emergency department or admission; or for
all-cause death. Time to return was analyzed using Cox regression and negative
binomial models and adjusted for age, gender, race, marital status, and risk
factors (hypertension, hyperlipidemia, diabetes, smoking and obesity). Direct
total costs included inpatient, outpatient and fee basis (non-VA) costs. RESULTS:
Of 749,036 patients, 20,521 had UCP and 5303 had CAD. UCP patients were young and
had a lower burden of risk factors than CAD cohort (p .01). Yet, these patients
were likely to return earlier with any chest pain (adjusted Hazard Ratio [aHR]?=
1.76; 95 % CI 1.65-1.88); or unexplained chest pain than CAD patients (aHR: 1.89;
95 % CI 1.77-2.01). UCP patients were also likely to return more frequently for
any chest pain (aRate Ratio = 1.54; 95 % CI 1.43-1.64) or UCP than CAD patients
(aRR =2.63; 95 % CI 2.43-2.87). Per 100 patients, the 1-year cumulative returns
were 37 visits for reference group and 45 visits for UCP cohort. The annual costs
for chest pain averaged $69,009 for CAD and $57,336 for UCP patients (log
geometric mean ratio=1.25; 95 % CI 1.18-1.32). CONCLUSION: Chest pain recidivism
is common and costly even in patients without known CAD. We need evidence-based
guidelines for these patients to minimize returns.