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Epidemiology

Psychological morbidity and illness appraisals of patients with cardiac and non-cardiac chest pain attending a rapid access chest pain clinic: a longitudinal cohort study

N Robertson¹, N Javed², N J Samani³ and K Khunti⁴

¹ School of Psychology, University of Leicester, UK
² School of Medicine, University of Leicester, UK
³ Department of Cardiovascular Sciences, University of Leicester, UK
⁴ Department of Health Sciences, University of Leicester, UK

Correspondence to:
Dr N Robertson, School of Psychology, University of Leicester, 104 Regent Road, Leicester LE1 7LT, UK; nr6{at}le.ac.uk

Objectives: To assess the psychological morbidity and illness beliefs in newly referred patients with chest pain, and to compare the psychological morbidity of patients with pain of cardiac origin with that of patients with pain of non-cardiac origin.

Design: Longitudinal cohort study.

Setting: Rapid Access Chest Pain Clinic in a tertiary referral centre in Leicester, United Kingdom.

Participants: 246 patients with acute, undifferentiated, chest pain followed up 1 week and 2 months subsequent to clinic attendance.

Main outcome measures: Levels of affective disturbance, health anxiety and illness perception.

Results: Levels of anxiety before clinic attendance exceeded community norms but did not differentiate the two groups. However, after clinic attendance levels of anxiety for those with a non-cardiac diagnosis significantly exceeded those of patients whose pain was of cardiac origin and remained above community norms 2 months hence. Non-cardiac patients viewed their condition as significantly less controllable and less understandable than those whose pain was cardiac in origin. Levels of depression for those with cardiac pain also significantly increased to above community norms after clinic attendance.

Conclusions: Clinical levels of psychological morbidity are evident in the immediate and long-term aftermath of a visit to a Rapid Access Chest Pain Clinic, despite early access and provision of reassurance. More structured interventions appear necessary to deal with both distress and illness beliefs that may influence future healthcare use.

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