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Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study

Jordan, Kelvin P; Rathod-Mistry, Trishna; van der Windt, Danielle A; Bailey, James; Chen, Ying; Clarson, Lorna; Denaxas, Spiros; Hayward, Richard A; Hemingway, Harry; Kyriacou, Theocharis; Mamas, Mamas A

Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study Thumbnail


Trishna Rathod-Mistry

James Bailey

Ying Chen

Spiros Denaxas

Richard A Hayward

Harry Hemingway

Theocharis Kyriacou


BACKGROUND: Most adults presenting in primary care with chest pain symptoms will not receive a diagnosis ("unattributed" chest pain) but are at increased risk of cardiovascular events. AIM: To assess within patients with unattributed chest pain, risk factors for cardiovascular events and whether those at greatest risk of cardiovascular disease can be ascertained by an existing general population risk prediction model or by development of a new model.

METHODS: The study used UK primary care electronic health records from the Clinical Practice Research Datalink (CPRD) linked to admitted hospitalisations. Study population was patients aged 18 plus with recorded unattributed chest pain 2002-2018. Cardiovascular risk prediction models were developed with external validation and comparison of performance to QRISK3, a general population risk prediction model.

RESULTS: There were 374,917 patients with unattributed chest pain in the development dataset. Strongest risk factors for cardiovascular disease included diabetes, atrial fibrillation, and hypertension. Risk was increased in males, patients of Asian ethnicity, those in more deprived areas, obese patients, and smokers. The final developed model had good predictive performance (external validation c-statistic 0.81, calibration slope 1.02). A model using a subset of key risk factors for cardiovascular disease gave nearly identical performance. QRISK3 underestimated cardiovascular risk.

CONCLUSION: Patients presenting with unattributed chest pain are at increased risk of cardiovascular events. It is feasible to accurately estimate individual risk using routinely recorded information in the primary care record, focusing on a small number of risk factors. Patients at highest risk could be targeted for preventative measures.

Journal Article Type Article
Acceptance Date Feb 10, 2023
Online Publication Date Mar 10, 2023
Publication Date 2023-08
Publicly Available Date May 30, 2023
Journal European Journal of Preventive Cardiology
Print ISSN 2047-4873
Electronic ISSN 2047-4881
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 30
Issue 11
Pages 1151-1161
Keywords Cardiology and Cardiovascular Medicine, Epidemiology
Publisher URL
Additional Information
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.