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Many people who have a stroke or heart attack will already suffer from musculoskeletal pain (for example, back pain). This pain, alongside poor function and sleep interference resulting from the pain, may reduce effectiveness or receipt of appropriate treatment for their stroke or heart attack.

We previously showed, using CPRD GOLD, that people with musculoskeletal pain have longer hospital stays for heart attack and are more likely to be readmitted within 30 days of discharge.

The objectives of this study are to assess if we get similar findings using CPRD Aurum, whether in-hospital management and longer-term outcomes are different if people have musculoskeletal pain, and whether any differences are higher in certain groups of patients (e.g., by age).

We will analyse data of patients aged 45 years and over newly diagnosed with a heart attack or stroke. We will first assess consistency of findings with GOLD on the relationship between pre-existing musculoskeletal pain and length of hospital stay, readmission, and in-hospital outcomes such as death.

We will then follow patients after discharge through their records to investigate links between musculoskeletal pain and longer term outcomes including having a further stroke or heart attack, early mortality, health service use and costs. We will compare management of stroke and heart attack in-hospital between those with musculoskeletal pain and those without such pain as a possible explanation for differences in outcome.

We will examine if findings vary by type of painful condition (such as back pain or knee pain), or by age, gender, ethnicity, and deprivation.