AIM: To compare various health-related aspects of quality of life during long-term follow-up after admission to hospital due to acute chest pain in a city university hospital and a county hospital. METHODS: This was a retrospective survey of all chest pain patients > or = 30 years of age at the Sahlgrenska University Hospital, Göteborg, covering an area with 706 inhabitants per km2 and at Uddevalla County Hospital, Uddevalla, covering an area with 34 inhabitants per km2 over a period of six months. After 30 months all patients alive were approached with a questionnaire in which they were asked about various aspects of health-related quality of life and use of medication. RESULTS: In all, 1,813 patients in the city hospital and 804 patients in the county hospital took part in the survey. The mortality and the overall proportion of patients requiring rehospitalization was similar in the two cohorts. Thirty months after onset of symptoms there was a difference between the two study populations. Patients in the county hospital smoked less frequently (p = 0.004). They tended to have less problems with chest pain at rest (p < 0.05) and dyspnoea at slight physical exercise (p = 0.01). Furthermore, they had less emotional symptoms (p = 0.003) and their state of health caused fewer problems when doing housekeeping (p = 0.008). Differences with regard to emotional symptoms and problems when doing housekeeping were particularly observed among women, whereas smoking habits differed only among men. CONCLUSION: When comparing patients admitted to hospital with acute chest pain in a city university hospital and a county hospital after 30 months some differences appeared. Patients in the county hospital appeared to suffer from less symptoms than patients in the city hospital. This was particularly observed among women. The mechanisms behind these observations are not clear.