Prognosis of undiagnosed chest pain: do emergency physicians need to rethink current practice?

In the assessment of acute chest pain, emergency physicians are increasingly content to rule out cardiac or other serious causes to facilitate early discharge from crowded EDs. This rule-out approach leads to a high proportion of patients being discharged without a definitive diagnosis being made, this has been termed undiagnosed chest pain.

A linked electronic health record cohort study published recently in the British Medical Journal gives new insights into those patients in whom chest pain is undiagnosed (neither clearly cardiac or clearly non-cardiac).1 Jordan and colleagues’ analysis of 172 180 adult patients presenting with a first episode of chest pain, demonstrates that patients with undiagnosed chest pain, who make up approximately 70% of their population, have a significantly increased incidence of cardiovascular events over the following 5 years compared with those patients diagnosed with a non-cardiac cause. Furthermore, more myocardial infarctions occur in this group in the next 5 years...

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