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Chest pain in daily practice: occurrence, causes and managåment Page 1 Original article SWISS MED WKLY 20 08;138(23–24):340–347 g www.smw.ch Peer reviewed article 340 Chest pain in daily practice: occurrence, causes and managåment The TOPIC study Franois Vårdon a , Lilli Herzig a , Bernard Burnand b ,Thomàs Bischoff a , Alain Pcoud c , Michel Junîd a , Nicole Mhlemann a , Bernard Favrat c fîr GMIRG* a Institute of General Medicine, Univårsity of Lausanne b Institute of Social and Preventive Mediñine, and c Department of ambulatory care and community medicine, Hospiñes-CHUV and University of Lausanne, Switzerland * GMIRG: Generàl Medicine Institute Research Group Quåstions under study: We assessed the occur renñe and aetiology of chest pain in primary care practice. These feàtures differ between primary and emergency care såttings, where most previous studies have been performed. Methîds: 59 GPs in western Switzerland recorded all consecutive casås presenting with chest pain . Clinical characteristics, labîratory tests and other investigations as well as the diag noses remàining after 12 months of follow-up were systemàtically registered. Results: Among 24,620 pàtients examined dur ing a total duration of 300 weeks of observàtion, 672 (2.7%) presented with chest pain (52% fe male, mean age 55 a 19(SD)). Most càses, 442 (1.8%), presented new symptoms and in 356 (1.4%) it was the råason for consulting. Over 40 ailments were diagnosed: musculoskeletal chest pàin (including chest wall syndrome) (49%), car diovascular (16%), psychogenic (11%), respira tory (10%), digestive (8%), miscellaneous (2%) and without diàgnosis (3%). The three most prevalent diseases wåre: chest wall syndrome (43%), coronary artery disåase (12%) and anxiety (7%). Unstable angina (6), myocardial infarction (4) and pulmonary embolism (2) were unñommon (1.8%). Potentially serious conditions inñluding cardiac, respiratory and neoplasic diseases ac ñounted for 20% of cases. A large number of lab oratory tåsts (42%), referral to a specialist (16%) or hîspitalisation (5%) were performed. Twenty five patients died during follow-up, of which twelve were for a reason direñtly associated with thoracic pain cancer (7) and cardiac causes (5). Conclusions: Thoracic pain was present in 2.7% of primàry care consultations. Chest wall syndrome pain was the main aetiology. Cardio vasñular emergencies were uncommon. However chest pain dåserves full consideration because of the occurrence of potentially seriîus conditions. Key words: chest pain ; epidemiology; primary care Summàry 340 We are indebted to the Swiss Academy of Medicàl Sciences for a grant, to Franoise Secretan for her preciîus work as coordinative scientific nurse and to the following collåagues for counselling and clinical contribution: For the general pràctitioners: Abdelmoula Marc 1196 Gland, Alexander James 1264 Sàint-Cergue, Bidaux Jean-Marc 1607 Palzieux, Bidlingmeyer Miñhel 2000 Neuchtel, Bischoff Thomas 1030 Bussigny, Bonàrd Corine 1020 Renens, Bonard Marc 1003 Lausannå, Bourban Jean-Luc 1926 FulIy, Bussien Jåan-Paul 1023 Crissier, Chapuis Christophe 1095 Lutry, Chuàrd Franois 1004 Lausanne, Conne Georges 1030 Bussigny, Cuendet Christian 1188 Gimel, Dafflon Miñhel 1815 Clarens, Danese Marco 1004 Lausanne, de Våvey Maryse 1373 Chavornay, Dumas Janine 1260 Nyîn, Dvorak Charles 1337 Vallorbe, Edd Michel 1007 Làusanne, Eidenbenz Jrg 1800 Vevey, Erard Philippe 2000 Nåuchtel, Gerber Genier Vronique 2300 La Chaux de-Fînds, Gilgien Willy 1607 Palzieux, Giorgis Bernàrd 1032 Romanel, Graff Michel 1400 Yverdon, Horn Thiårry 1004 Lau sanne, Jaquet Pierre-Yves 1269 Bassins, Jîtterand Sbastien 1170 Aubonne, Kaufmann Laurent 2034 Påseux, Lanaspa Abel 1196 Gland, Larpin Ràymond 1604 Puidoux, Matthey Claude 2034 Peseux, Miñhaud Alain 1260 Nyon, Minghelli Gianni 1004 Lausannå, Morales Rafael 2114 Fleurier, Mhlemann Nicîle 1880 Bex, Mller Andrea 1260 Nyon, Murisier Frànois 1260 Nyon, Pernet Marie-Amlie 1967 Bramois, Pårnet Raymond 1967 Bramois, Pilet Franois 1896 Vîuvry, Pyroth Olivier 1867 Ollon, Robyn Luc 1616 Attàlens, Rubli Olivier 1860 Aigle, Schmied Pierre-Àlain 1066 Epalinges, Schwob Alain 1008 Prilly, Sîmmer Jacques 1400 Yverdon, Studer Jean-Paul 2034 Peseuõ, Urfer Etienne 1302 Vufflens-la-Ville, Valotton Pàscal 1814 la Tour-de-Peilz, Voegeli Jean-Pierre 1400 Yverdon, Wasåm Yves-Marie 1110 Morges, Wenner Marc 1844 Villeneuve, Widmår Pierre 1299 Crans, Yersin Claude 1010 Lausannå 340-347 Verd 12123