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Cardiovascular medicine
Research
Chest pain and shortness of breath in cardiovascular disease: a prospective cohort study in UK primary care
  1. Lauren A Barnett1,
  2. James A Prior1,
  3. Umesh T Kadam2,
  4. Kelvin P Jordan1
  1. 1 Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
  2. 2 Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences, Keele University, Staffordshire, UK
  1. Correspondence to Dr. James A Prior; j.a.prior{at}keele.ac.uk

Abstract

Objective To determine characteristics associated with monthly chest pain and shortness of breath (SoB) during activity in cardiovascular disease (CVD) and trajectories of these symptoms over 10 months.

Study design and setting Baseline questionnaire was sent to patients aged ≥40 years from 10 UK general practices. Responders were sent monthly questionnaires for 10 months. For patients with CVD (ischaemic heart disease and heart failure), the association of sociodemographic characteristics, pain elsewhere and anxiety and depression with monthly reports of chest pain and SoB during activity were determined using multilevel, multinomial logistic regression. Common symptom trajectories were determined using dual trajectory latent class growth analysis.

Results 661 patients with CVD completed at least 5 monthly questionnaires. Multiple other pain sites (relative risk ratio: 4.03; 95% CI 1.64 to 9.91) and anxiety or depression (relative risk ratio: 3.31; 95% CI 1.89 to 5.79) were associated with reporting weekly chest pain. Anxiety or depression (relative risk ratio: 4.10; 95% CI 2.72 to 6.17), obesity (relative risk ratio: 2.53; 95% CI 1.49 to 4.30), older age (80+: relative risk ratio: 2.51; 95% CI 1.19 to 5.26), increasing number of pain sites (4+: relative risk ratio: 4.64; 95% CI 2.35 to 9.18) and female gender (relative risk ratio: 1.81; 95% CI 1.20 to 2.75) were associated with reporting weekly SoB. Eight symptom trajectories were identified, with SoB symptoms more common than chest pain.

Conclusions Potentially modifiable characteristics are associated with the experience of chest pain and SoB. Identified symptom trajectories may facilitate tailored care to improve outcomes in patients with CVD.

  • cardiovascular disease
  • chest pain
  • Ischaemic heart disease
  • Heart failure
  • shortness of breath

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-015857

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    Footnotes

    • The Research Institute for Primary Care & Health Sciences at Keele University has established data sharing arrangements to support joint publications and other research collaborations. Applications for access to anonymised data from our research databases are reviewed by the Institute’s Data Custodian and Academic Proposal (DCAP) Committee and a decision regarding access to the data is made subject to the NRES ethical approval first provided for the study and the new analysis being proposed. Further information on our data sharing procedures can be found on at (http://www.keele.ac.uk/pchs/publications/datasharingresources/) or by emailing the Institute’s data manager (primarycare.datasharing@keele.ac.uk)

    • Contributors Guarantor of overall study integrity: KPJ. Study concept and design: KPJ, JAP and UTK. Data collection and interpretation: LAB, KPJ, JAP and UTK. Statistical analysis: LAB and KPJ. Manuscript preparation: LAB, KPJ, JAP and UTK. Final approval of manuscript: LAB, KPJ, JAP and UTK.

    • Funding LAB is funded by a National Institute for Health Research (NIHR) Research Methods Fellowship, and UTK was funded by an NIHR Post-Doctoral Fellowship (grant no. PAS/PDA/03/07/035). The study sponsors had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Ethics approval Ethics approval for the 2C study was granted by Cheshire Research Ethics Committee (reference number 09/H1017/40).

    • Provenance and peer review Not commissioned; externally peer reviewed.