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

Noelle TA Robertson ^1*, Naveed Javed ¹, Nilesh J Samani ¹ and Kamlesh Khunti ¹

¹ University of Leicester, United Kingdom

^* To whom correspondence should be addressed. E-mail: nr6{at}le.ac.uk.

Accepted 13 March 2007

Abstract

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 to those of non-cardiac origin.

Design Longitudinal cohort study

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

Participants 247 patients with acute, undifferentiated, chest pain followed up one week and two months subsequent to clinic attendance.

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

Results Levels of anxiety prior to clinic attendance exceeded community norms but did not differentiate the two groups. However, subsequent to clinic attendance levels of anxiety for those with a non-cardiac diagnosis significantly exceeded those whose pain was of cardiac origin and remained above community norms two 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 address both distress and illness beliefs that may influence future health care use.

Keywords: Rapid Access Chest Pain Clinic;, illness appraisals, psychological morbidity, unexplained chest pain

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