Patients admitted to hospital with chest pain — Changes in a 20-year perspective

Abstract

ObjectivesTo describe the differences in characteristics and outcome between two consecutive series of patients admitted to hospital with chest pain in a 20-year perspective. Particular emphasis is placed on changes in outcome in relation to the initial electrocardiogram (ECG). SubjectsIn the two periods, 1986–1987 and 2008, all patients with chest pain admitted to the study hospitals in Gothenburg, Sweden, were included. ResultsFive thousand and sixteen patients were registered in a period of 21months in 1986–1987 and 2287 patients were registered during 3months in 2008. In a comparison of the two time periods, the age of chest pain patients was not significantly different (mean age 60.1±17.8years in 1986–1987 and 59.8±19.1years in 2008, p=0.50). There was a lower prevalence of previous angina pectoris, congestive heart failure and current smoking in the second period, whereas a history of acute myocardial infarction, hypertension and diabetes mellitus had become more prevalent. The use of cardio-protective drugs increased and ECG changes indicating acute myocardial ischemia on admission to hospital decreased. Length of hospitalisation was reduced from a median of 5days to 3days (p<0.0001). A significant decrease in 30-day and 1-year mortality was found (3.8% in 1986–1987 vs 2.0% in 2008 and 9.9% vs 6.3% respectively, p<0.0001 for both comparisons). ConclusionsDuring a period of 20years, the characteristics and outcome of patients admitted to hospital with chest pain changed. The most important changes were a lower prevalence of ECG signs indicating acute myocardial ischemia on admission, shorter hospitalisation time and a lower 30-day and 1-year mortality.