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Musculoskeletal pain and its impact on prognosis following acute coronary syndrome or stroke: A linked electronic health record cohort study

Mason, Kayleigh J.; Jordan, Kelvin P.; Heron, Neil; Edwards, John J.; Bailey, James; Achana, Felix A.; Chen, Ying; Frisher, Martin; Huntley, Alyson L.; Mallen, Christian D.; Mamas, Mamas A.; Ee Png, May; Tatton, Stephen; White, Simon; Marshall, Michelle

Musculoskeletal pain and its impact on prognosis following acute coronary syndrome or stroke: A linked electronic health record cohort study Thumbnail


John J. Edwards

Felix A. Achana

Ying Chen

Alyson L. Huntley

May Ee Png

Stephen Tatton


OBJECTIVE: Musculoskeletal painful conditions are a risk factor for cardiovascular disease (CVD), but less is known about whether musculoskeletal pain also worsens prognosis from CVD. The objective was to determine whether patients with musculoskeletal pain have poorer prognosis following acute coronary syndrome (ACS) or stroke.

METHODS: The study utilised UK electronic primary care records (CPRD Aurum) with linkage to hospital and mortality records. Patients aged =45 years admitted to hospital with incident ACS/stroke were categorised by healthcare use for musculoskeletal pain (inflammatory conditions, osteoarthritis [OA], and regional pain) based on primary care consultations in the prior 24 months. Outcomes included mortality, length of stay, readmission and management of index condition (ACS/stroke).

RESULTS: There were 171,670 patients with incident ACS and 138,512 with stroke; 30% consulted for musculoskeletal pain prior to ACS/stroke and these patients had more comorbidity than those without musculoskeletal pain. Rates of mortality and readmission, and length of stay were higher in those with musculoskeletal pain, particularly OA and inflammatory conditions, in ACS. Readmission was also higher for patients with musculoskeletal pain in stroke. However, increased risks associated with musculoskeletal pain did not remain after adjustment for age and polypharmacy. Inflammatory conditions were associated with increased likelihood of prescriptions for dual anti-platelets (ACS only) and anti-coagulants.

CONCLUSIONS: Patients with musculoskeletal pain have higher rates of poor outcome from ACS which relates to being older but also increased polypharmacy. The high rates of comorbidity including polypharmacy highlight the complexity of patients with musculoskeletal pain who have new onset ACS/stroke.

Journal Article Type Article
Acceptance Date Feb 13, 2023
Online Publication Date Feb 28, 2023
Publication Date Feb 28, 2023
Publicly Available Date May 30, 2023
Journal Musculoskeletal Care
Print ISSN 1478-2189
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 21
Issue 3
Pages 749-762
Keywords acute coronary syndrome; cerebrovascular accident; epidemiology; musculoskeletal pain; primary care; stroke; Nursing (miscellaneous), Rehabilitation, Physical Therapy, Sports Therapy and Rehabilitation, Orthopedics and Sports Medicine, Chiropractics, Rheu
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