Chest pain syndromes are associated with high rates of recidivism and costs in young United States Veterans Epidemiology and research methodology in primary care

Basmah Safdar, James Dziura, Harini Bathulapalli, Douglas Leslie, Melissa Skanderson, Cynthia Brandt, Sally G. Haskell

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article number88
JournalBMC Family Practice
Volume16
Issue number1
DOIs
StatePublished - Jul 23 2015

Fingerprint

Veterans
Chest Pain
Primary Health Care
Epidemiology
Research Design
Costs and Cost Analysis
Coronary Artery Disease
International Classification of Diseases
Afghanistan
Iraq
Fees and Charges
Marital Status
Statistical Models
Hyperlipidemias

All Science Journal Classification (ASJC) codes

  • Family Practice

Cite this

Safdar, Basmah ; Dziura, James ; Bathulapalli, Harini ; Leslie, Douglas ; Skanderson, Melissa ; Brandt, Cynthia ; Haskell, Sally G. / Chest pain syndromes are associated with high rates of recidivism and costs in young United States Veterans Epidemiology and research methodology in primary care. In: BMC Family Practice. 2015 ; Vol. 16, No. 1.
@article{9c076d1672e640a4a3133609302e553f,
title = "Chest pain syndromes are associated with high rates of recidivism and costs in young United States Veterans Epidemiology and research methodology in primary care",
abstract = "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.",
author = "Basmah Safdar and James Dziura and Harini Bathulapalli and Douglas Leslie and Melissa Skanderson and Cynthia Brandt and Haskell, {Sally G.}",
year = "2015",
month = "7",
day = "23",
doi = "10.1186/s12875-015-0287-9",
language = "English (US)",
volume = "16",
journal = "BMC Family Practice",
issn = "1471-2296",
publisher = "BioMed Central",
number = "1",

}

Chest pain syndromes are associated with high rates of recidivism and costs in young United States Veterans Epidemiology and research methodology in primary care. / Safdar, Basmah; Dziura, James; Bathulapalli, Harini; Leslie, Douglas; Skanderson, Melissa; Brandt, Cynthia; Haskell, Sally G.

In: BMC Family Practice, Vol. 16, No. 1, 88, 23.07.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Chest pain syndromes are associated with high rates of recidivism and costs in young United States Veterans Epidemiology and research methodology in primary care

AU - Safdar, Basmah

AU - Dziura, James

AU - Bathulapalli, Harini

AU - Leslie, Douglas

AU - Skanderson, Melissa

AU - Brandt, Cynthia

AU - Haskell, Sally G.

PY - 2015/7/23

Y1 - 2015/7/23

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84937413087&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937413087&partnerID=8YFLogxK

U2 - 10.1186/s12875-015-0287-9

DO - 10.1186/s12875-015-0287-9

M3 - Article

VL - 16

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

IS - 1

M1 - 88

ER -