The growing number of Americans with cardiovascular disease has caused a heightened sensitivity in the evaluation of chest pain.

In a study published in the April issue of the Mayo Clinic Proceedings journal, researchers reported that patients dismissed from hospitals with noncardiac chest pain continue to experience cardiac events, which might highlight a need for more aggressive cardiovascular risk-factor management.

Noncardiac chest pain is attributed to a variety of disorders, including what's called gastroesophageal reflux disease (GERD) and esophageal hypersensitivity, panic attacks, musculoskeletal pain, and microvascular disease, also called cardiac syndrome.

Researchers identified 320 patients with a diagnosis of noncardiac chest pain to determine the frequency of gastrointestinal (GI) consultations and testing, and to identify the frequency of cardiac death. All patients had a hospital admission diagnosis of unstable angina, subsequent inpatient cardiac evaluation, and a dismissal diagnosis of noncardiac chest pain.

The first aim of the study was to determine the frequency of GI consultation and testing. After the initial diagnosis of noncardiac chest pain, 49 percent of patients were re-evaluated in the emergency department, and 42 percent underwent repeated cardiology evaluations. Only 15 percent had GI consultations.

"Patients in this study received few GI consultations and underwent even fewer GI tests. Further study is needed to determine whether patients with noncardiac chest pain would benefit from more frequent GI consultations and more diverse use of GI testing," says Dr. Michael Leise, co-investigator in the Mayo Clinic's gastroenterology department.

The study's second aim was to report on overall mortality, specifically, cardiac death in patients with noncardiac chest pain. Although prognosis for patients with noncardiac chest pain is thought to be favorable, researchers found that previous data to support this view were limited.

The total sample in the study didn't display a significantly increased frequency of death compared with what would be expected in this community, but a substantial number of cardiac deaths occurred in a noncardiac chest pain population.

"We speculate that cardiac death in patients with noncardiac chest pain may relate to overlapping risk factors for GERD and coronary-artery disease, including obesity, obstructive sleep apnea, diabetes mellitus, and smoking," Leise says.

Until cardiac death in this population is better understood, it's important to screen for cardiac risk factors such as hypertension, high levels of cholesterol in the blood, and diabetes, and to aggressively manage these simultaneously occurring conditions, researchers say.

A monthly peer-reviewed journal, Mayo Clinic Proceedings, publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research, and clinical epidemiology. It's published by the Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally.