People who go to the emergency room with chest pain and are told that it is not caused by a heart attack or angina might want to get a second opinion. Findings from a new study indicate that on rare occasions heart-related chest pain is incorrectly chalked up to something else.

In the study, nearly 3 percent of patients who were sent home with a diagnosis of non-heart chest pain went on to have a heart attack or related problem in the next 30 days, Dr. Chadwick Miller of Wake Forest University, Winston-Salem, North Carolina, and colleagues report.

Patients with heart disease risk factors, such as diabetes or High cholesterol, were at greatest risk, according to the report in the Annals of Emergency Medicine.

“I would suggest patients with high-risk features should not be considered (non-heart) unless the treating physician is absolutely confident,” Miller told Reuters Health. “Essentially, I would lower my threshold for doing a (heart) evaluation in these patients.”

While ER doctors tend to err on the side of caution when treating patients with chest pain, often admitting them for observation, physicians are under pressure to cut costs, the authors note. The researchers set out to determine whether some patients with apparent non-heart chest pain might need additional evaluation.

The findings are based on a study of 2992 patients who were diagnosed with non-heart chest pain.

Despite their diagnosis, 2.8 percent of patients experienced a heart attack or related event in the next 30 days. Factors associated with such an event included male sex, older age, and traditional heart disease risk factors.

The average age for patients who experienced such events was 61.2, compared to 47.9 for those who did not. Patients who complained of weakness, as well as those whose main complaint was not chest pain, were more likely to have a heart-related problem.

Miller said that people diagnosed with non-heart chest pain may “deserve closer scrutiny” in order to identify cases that are really caused by the heart. However, even with closer scrutiny, he says it is likely that a small percentage of heart attacks will always be missed.

SOURCE: Annals of Emergency Medicine, December 2004.