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Noncardiac Chest Pain: The Role of the Cardiologist-A National Survey

Wong, Wai-Man MD*; Risner-Adler, Sara*; Beeler, Joy MPH*; Habib, Sara*; Bautista, Jimmy MD*; Goldman, Steven MD, FACC; Fass, Ronnie MD*

Journal of Clinical Gastroenterology: November-December 2005 - Volume 39 - Issue 10 - p 858-862
doi: 10.1097/01.mcg.0000180635.92313.3b
Alimentary Tract: Clinical Research

Background: The current assumption is that noncardiac chest pain (NCCP) patients diagnosed by a cardiologist are commonly referred to a gastroenterologist for further evaluation. Thus far, there are no studies that assess the clinical approach and referral patterns of cardiologists when evaluating subjects with NCCP.

Aim: To determine the extent of involvement of cardiologists in the management of NCCP patients.

Methods: Cardiologists were randomly selected from the American College of Cardiology national membership list and sent a 20-item questionnaire that included demographic information, characteristics of practice, preferences of diagnostic tests, referral patterns, and treatment plans.

Results: A total of 246 (33%) cardiologists returned the questionnaire. A mean of 12.6% of patients were diagnosed with NCCP and 45.5% were treated by a cardiologist in the past 6 months. Of the NCCP patients that were referred, most ended up in the primary care physician clinic (45.9%) followed by gastroenterologist clinic (29.3%). Most cardiologists are either comfortable (35%) or very comfortable (43.1%) in diagnosing NCCP. Proton pump inhibitors (44.9%), lifestyle modifications (28.7%), and H2 blockers (11.8%) are the three most commonly used therapeutic modalities for NCCP.

Conclusion: Cardiologists manage about half of the diagnosed NCCP patients by themselves. Of those NCCP patients that are referred, cardiologists prefer to send them to a primary care physician rather than a gastroenterologist.

From the *Neuro-Enteric Clinical Research Group, Section of Gastroenterology and †Section of Cardiology, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center and Sarver Heart Center, Tucson, AZ. The current affiliation of Dr. Wong is Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.

Received for publication January 11, 2005; accepted March 29, 2005.

Dr. Wong is an RGC clinical research fellow and is supported by the Competitive Earmarked Research Grant HKU 7487/03M of the Hong Kong Research Grant Council, Hong Kong. Supported in part by TAP Pharmaceutica.

Reprints: Ronnie Fass, MD, FACP, FACG, Southern Arizona VA Health Care System, 3601 South Sixth Avenue (1-111G-1), Tucson, AZ 85723-0001 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.