Chest pain epidemiology and demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

There is a significant difference in the epidemiology of chest pain in outpatient and emergency settings. The incidence of chest pain is approximately 1,500 per 100,000 individuals worldwide. According to a study conducted in Belgium, the prevalence of chest pain is approximately 2000-5000 per 100,000 individuals worldwide. The incidence of patients presenting with chest pain increases with age and men are more likely to present with chest pain than women.

Epidemiology and Demographics

Incidence

There is a significant difference in the epidemiology of chest pain in outpatient and emergency settings.
The incidence of chest pain is approximately 1,500 per 100,000 individuals worldwide. ^[1]
A cross-sectional study conducted in Germany and published in 2016, found the incidence of chest pain was estimated to be 700-3000 cases per 100,000 individuals worldwide. ^[2]
Cardiovascular causes such as MI, angina, heart failure, and pulmonary embolism account for 50,000 per 100,000 cases of chest pain seen in the emergency department. ^[3]
In the outpatient setting, musculoskeletal pain, gastrointestinal causes, panic disorder, and other psychiatric conditions predominate. ^[4]^[5]
In the United States, pulmonary causes account for 5,000 per 100,000 cases of chest pain^[6] in the emergency department with the main causes being pulmonary embolism, pneumonia, spontaneous pneumothorax and pleurisy. ^[7]^[8]
Non-specific chest pain has an incidence of 16,000 per 100,000 cases. ^[6]

Prevalence

Approximately a quarter of the population experiences chest pain in some form during their lifetime. ^[8]^[9]
According to a study conducted in Belgium, the prevalence of chest pain is approximately 2000-5000 per 100,000 individuals worldwide. ^[10]^[11]
The prevalence of chest pain in the office setting is approximately 1000-2000 per 100, 000 individuals worldwide. ^[12]
The prevalence of non-traumatic chest pain in the emergency department is 1,660 per 100,000 individuals. ^[8]

Case-fatality rate/Mortality rate

The mortality rate of chest pain is approximately 3%. ^[13]
Patients with a myocardial infarction that presented without chest pain had a mortality rate of 23.3% compared with 9.3% in patients who had chest pain as a presentation. ^[14]

Age

Patients of all age groups may develop chest pain.
The incidence of patients presenting with chest pain increases with age; the median age being 53 years. ^[15]^[16]

Race

One retrospective descriptive study ^[8] found that 75% of patients presenting to the emergency department of a hospital in Pretoria were black but most of the patients with cardiovascular disease (51%) were white.

Gender

Men are more likely to present with chest pain than women.
The female to male ratio is approximately 0.8 to 1. ^[17]
Women with a myocardial infarction are more likely than men to present without chest pain. This often leads to a missed diagnosis.

References

↑ Johnson K, Ghassemzadeh S. PMID 29262011. Missing or empty |title= (help)
↑ Frese T, Mahlmeister J, Heitzer M, Sandholzer H (2016). “Chest pain in general practice: Frequency, management, and results of encounter”. J Family Med Prim Care. 5 (1): 61–6. doi:10.4103/2249-4863.184625. PMC 4943151. PMID 27453845.
↑ Buntinx F, Knockaert D, Bruyninckx R, de Blaey N, Aerts M, Knottnerus JA, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18:586-9
↑ Buntinx F, Knockaert D, Bruyninckx R, de Blaey N, Aerts M, Knottnerus JA, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18:586-9
↑ Klinkman MS, Stevens D, Gorenflo DW. Episodes of care for chest pain: a preliminary report from MIRNET. J Fam Pract. 1994;38:345-52
↑ ^6.0 ^6.1 “Diagnosing the Cause of Chest Pain – American Family Physician”.
↑ Cannon C, Lee T. Approach to the patient with chest pain In: Libby P, Bonow R, Zipes D, Mann D, editors. Braunwald’s heart disease: A textbook of cardiovascular medicine. 8th ed. Saunders Elsevier: Philadelphia; 2007; p. 1195–1204
↑ ^8.0 ^8.1 ^8.2 ^8.3 Geyser M, Smith S (June 2016). “Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria”. Afr J Prim Health Care Fam Med. 8 (1): e1–5. doi:10.4102/phcfm.v8i1.1048. PMC 4926718. PMID 27380782.
↑ Fothergill NJ, Hunt MT, Touquet R (September 1993). “Audit of patients with chest pain presenting to an accident and emergency department over a 6-month period”. Arch Emerg Med. 10 (3): 155–60. doi:10.1136/emj.10.3.155. PMC 1285980. PMID 8216586.
↑ Knockaert DC, Buntinx F, Stoens N, Bruyninckx R, Delooz H (March 2002). “Chest pain in the emergency department: the broad spectrum of causes”. Eur J Emerg Med. 9 (1): 25–30. doi:10.1097/00063110-200203000-00007. PMID 11989492.
↑ Eslick GD, Fass R (June 2003). “Noncardiac chest pain: evaluation and treatment”. Gastroenterol. Clin. North Am. 32 (2): 531–52. doi:10.1016/s0889-8553(03)00029-3. PMID 12858605.
↑ Klinkman M. Chest pain In: Taylor RRW, La Plante M, Pancotti R, editors. Manual of family practice. 2nd ed. Lippincott Williams & Wilkins: Philadelphia; 2002; p. 51–57
↑ Ana Ruigómez, Luis Alberto García Rodríguez, Mari-Ann Wallander, Saga Johansson, Roger Jones, Chest pain in general practice: incidence, comorbidity and mortality, Family Practice, Volume 23, Issue 2, April 2006, Pages 167–174, https://doi.org/10.1093/fampra/cmi124
↑ “Prevalence, Clinical Characteristics, and Mortality Among Patients With Myocardial Infarction Presenting Without Chest Pain | Acute Coronary Syndromes | JAMA | JAMA Network”.
↑ Aguilera P, Altamirano R, Pineda N, Bellolio M, Alvizú S, Mardónez JM. 179: Disposition and final diagnosis of patients presenting with chest pain to an academic emergency department in Chile. Ann Emerg Med. 2009:54(3):S55 http://dx.doi.org/10.1016/j.annemergmed.2009.06.207
↑ Henderson SO, Ostrzega E, Genna T, Matayoshi D, Alcocer L. Demographics, descriptions, diagnosis, and disposition of 1,677 chest pain patients in an indigent acute care hospital. Ann Emerg Med. 1999;34(4):S105 http://dx.doi.org/10.1016/S0196-
↑ Ana Ruigómez, Luis Alberto García Rodríguez, Mari-Ann Wallander, Saga Johansson, Roger Jones, Chest pain in general practice: incidence, comorbidity and mortality, Family Practice, Volume 23, Issue 2, April 2006, Pages 167–174, https://doi.org/10.1093/fampra/cmi124

[pmid29262011-1] Johnson K, Ghassemzadeh S. PMID 29262011. Missing or empty |title= (help)

[pmid27453845-2] Frese T, Mahlmeister J, Heitzer M, Sandholzer H (2016). “Chest pain in general practice: Frequency, management, and results of encounter”. J Family Med Prim Care. 5 (1): 61–6. doi:10.4103/2249-4863.184625. PMC 4943151. PMID 27453845.

[3] Buntinx F, Knockaert D, Bruyninckx R, de Blaey N, Aerts M, Knottnerus JA, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18:586-9

[4] Buntinx F, Knockaert D, Bruyninckx R, de Blaey N, Aerts M, Knottnerus JA, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18:586-9

[5] Klinkman MS, Stevens D, Gorenflo DW. Episodes of care for chest pain: a preliminary report from MIRNET. J Fam Pract. 1994;38:345-52

[urlDiagnosing_the_Cause_of_Chest_Pain_-_American_Family_Physician-6] 6.0 ^6.1 “Diagnosing the Cause of Chest Pain – American Family Physician”.

[7] Cannon C, Lee T. Approach to the patient with chest pain In: Libby P, Bonow R, Zipes D, Mann D, editors. Braunwald’s heart disease: A textbook of cardiovascular medicine. 8th ed. Saunders Elsevier: Philadelphia; 2007; p. 1195–1204

[pmid27380782-8] 8.0 ^8.1 ^8.2 ^8.3 Geyser M, Smith S (June 2016). “Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria”. Afr J Prim Health Care Fam Med. 8 (1): e1–5. doi:10.4102/phcfm.v8i1.1048. PMC 4926718. PMID 27380782.

[pmid8216586-9] Fothergill NJ, Hunt MT, Touquet R (September 1993). “Audit of patients with chest pain presenting to an accident and emergency department over a 6-month period”. Arch Emerg Med. 10 (3): 155–60. doi:10.1136/emj.10.3.155. PMC 1285980. PMID 8216586.

[pmid11989492-10] Knockaert DC, Buntinx F, Stoens N, Bruyninckx R, Delooz H (March 2002). “Chest pain in the emergency department: the broad spectrum of causes”. Eur J Emerg Med. 9 (1): 25–30. doi:10.1097/00063110-200203000-00007. PMID 11989492.

[pmid12858605-11] Eslick GD, Fass R (June 2003). “Noncardiac chest pain: evaluation and treatment”. Gastroenterol. Clin. North Am. 32 (2): 531–52. doi:10.1016/s0889-8553(03)00029-3. PMID 12858605.

[12] Klinkman M. Chest pain In: Taylor RRW, La Plante M, Pancotti R, editors. Manual of family practice. 2nd ed. Lippincott Williams & Wilkins: Philadelphia; 2002; p. 51–57

[13] Ana Ruigómez, Luis Alberto García Rodríguez, Mari-Ann Wallander, Saga Johansson, Roger Jones, Chest pain in general practice: incidence, comorbidity and mortality, Family Practice, Volume 23, Issue 2, April 2006, Pages 167–174, https://doi.org/10.1093/fampra/cmi124

[urlPrevalence,_Clinical_Characteristics,_and_Mortality_Among_Patients_With_Myocardial_Infarction_Presenting_Without_Chest_Pain_|_Acute_Coronary_Syndromes_|_JAMA_|_JAMA_Network-14] “Prevalence, Clinical Characteristics, and Mortality Among Patients With Myocardial Infarction Presenting Without Chest Pain | Acute Coronary Syndromes | JAMA | JAMA Network”.

[15] Aguilera P, Altamirano R, Pineda N, Bellolio M, Alvizú S, Mardónez JM. 179: Disposition and final diagnosis of patients presenting with chest pain to an academic emergency department in Chile. Ann Emerg Med. 2009:54(3):S55 http://dx.doi.org/10.1016/j.annemergmed.2009.06.207

[16] Henderson SO, Ostrzega E, Genna T, Matayoshi D, Alcocer L. Demographics, descriptions, diagnosis, and disposition of 1,677 chest pain patients in an indigent acute care hospital. Ann Emerg Med. 1999;34(4):S105 http://dx.doi.org/10.1016/S0196-

[17] Ana Ruigómez, Luis Alberto García Rodríguez, Mari-Ann Wallander, Saga Johansson, Roger Jones, Chest pain in general practice: incidence, comorbidity and mortality, Family Practice, Volume 23, Issue 2, April 2006, Pages 167–174, https://doi.org/10.1093/fampra/cmi124

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