Abstract
To investigate the incidence of major adverse cardiac events (MACEs) after discharge from the emergency department (ED) with unspecified chest pain and the predictive value of cardiovascular risk factors included in HEART score. This was a register-based retrospective cohort study including all patients discharged with the diagnosis 'unspecified chest pain' from Swedish EDs between 2006-2013. Diagnosis and drug prescriptions were collected from national registers and the association to the occurrence of MACE was studied with logistic regression and category-free net reclassification improvement (cNRI). Out of 74,329 included patients 619 (0.8%) experienced MACE within 30 days of discharge from the ED. Hypertension (odds ratio (OR) 4.74, 95% confidence interval (CI) 4.02-5.59), diabetes mellitus (3.76, 3.10-4.57), hyperlipidaemia (1.92, 1.51-2.44), and earlier cardiovascular disease (CVD) were all associated with MACE. The addition of hypertension to a risk factor model improved net reclassification (cNRI 53%, 95% CI 29-67%). The variables age (A) (1 point OR 7.01, 95% CI 4.79-10.26, 2 points OR 23.57, 95% CI 16.35-33.97) and risk factors (R) (1 point OR 3.76, 95% CI 3.05-4.63, 2 points OR 10.94, 95% CI 8.96-13.38) in HEART scor...Continue Reading
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