MedWire News: Chest pain causes significant anxiety and depression even after people have been told that is not due to cardiovascular disease, say UK researchers.
The results of a longitudinal study carried out at the Rapid Access Chest Pain Clinic at the University of Leicester show that people with non-cardiac chest pain (NCCP) exhibit higher levels of anxiety than those with cardiac chest pain for up to 2 months after being given the all clear. Conversely, those who receive a diagnosis of cardiac chest pain experience higher levels of depression.
"Up to 70% of patients present with pain of non-cardiac origin and often receive neither definitive diagnosis nor conclusive information," N Robertson and colleagues write in the journal Heart. "Even for those whose distress does not reach that of a psychiatric patient, a substantial majority will continue to experience distress and disability."
To find out the extent and duration of psychological morbidity in patients with chest pain referred to their clinic, Robertson and team sent out questionnaires for 371 patients to complete before their initial appointment. The questionnaires asked about the patient's demographic background and medical history, as well as their psychological wellbeing. Patients were re-assessed 1 week and 2 months after their first consultation.
The initial response rate was 66%, with 246 patients completing the questionnaires before their first visit to the clinic. The response rate was slightly lower at 1 week (47%) and 2 months (38%).
Robertson and colleagues report that the median time between completing the questionnaire and attending the clinic for the first time was 12 days and that there was a significant level of anxiety among all referred patients prior to their first visit.
However, 1 week after their consultation, patients with NCCP had significantly higher levels of anxiety than those with chest pain with a likely cardiac cause.
"For those with non-cardiac pain, levels of anxiety remained in excess of community norms 2 months after clinic attendance," report Robertson et al. They add that NCCP patients felt that their condition was less treatable and "perceived themselves to have less personal control over their condition." NCCP patients also exhibited less understanding of their symptoms.
The team suggests that rapid access chest pain services should take psychological wellbeing into account and focus on helping patients deal with anxiety and referring them to appropriate primary care services if necessary.
Annika Rosengren, from Sahlgrenska University Hospital in Stockholm, Sweden, supports this recommendation. She wrote in an accompanying editorial: "Clearly, dealing with the larger group of patients with undifferentiated chest pain, will require a multidisciplinary approach."
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