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Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study

Jordan, Kelvin P; Rathod-Mistry, Trishna; van der Windt, Danielle A; Bailey, James; Chen, Ying; Clarson, Lorna; Denaxas, Spiros; ... Mamas, Mamas A; + view all (2023) Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study. European Journal of Preventive Cardiology , Article zwad055. 10.1093/eurjpc/zwad055. (In press). Green open access

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Abstract

BACKGROUND: Most adults presenting in primary care with chest pain symptoms will not receive a diagnosis ("unattributed" chest pain) but are at increased risk of cardiovascular events. AIM: To assess within patients with unattributed chest pain, risk factors for cardiovascular events and whether those at greatest risk of cardiovascular disease can be ascertained by an existing general population risk prediction model or by development of a new model. METHODS: The study used UK primary care electronic health records from the Clinical Practice Research Datalink (CPRD) linked to admitted hospitalisations. Study population was patients aged 18 plus with recorded unattributed chest pain 2002-2018. Cardiovascular risk prediction models were developed with external validation and comparison of performance to QRISK3, a general population risk prediction model. RESULTS: There were 374,917 patients with unattributed chest pain in the development dataset. Strongest risk factors for cardiovascular disease included diabetes, atrial fibrillation, and hypertension. Risk was increased in males, patients of Asian ethnicity, those in more deprived areas, obese patients, and smokers. The final developed model had good predictive performance (external validation c-statistic 0.81, calibration slope 1.02). A model using a subset of key risk factors for cardiovascular disease gave nearly identical performance. QRISK3 underestimated cardiovascular risk. CONCLUSION: Patients presenting with unattributed chest pain are at increased risk of cardiovascular events. It is feasible to accurately estimate individual risk using routinely recorded information in the primary care record, focusing on a small number of risk factors. Patients at highest risk could be targeted for preventative measures.

Type: Article
Title: Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/eurjpc/zwad055
Publisher version: https://doi.org/10.1093/eurjpc/zwad055
Language: English
Additional information: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Keywords: Cardiovascular Disease, Chest pain, Electronic Health Records, Epidemiology, Primary Health Care, Risk
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology
URI: https://discovery.ucl.ac.uk/id/eprint/10166472
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