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Foldes-Busque G, Dionne CE, Tremblay MA, Turcotte S, Fleet RP, Archambault PM, Denis I. A prospective investigation of the prognosis of noncardiac chest pain in emergency department patients. J Psychosom Res 2024; 186:111883. [PMID: 39213941 DOI: 10.1016/j.jpsychores.2024.111883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/25/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES This study sought to describe the 2-year evolution of the intensity and frequency of noncardiac chest pain (NCCP), NCCP-related disability and health-related quality of life in a cohort of emergency department (ED) patients. It also aimed to identify and characterize subgroups of patients who share similar NCCP trajectories. METHODS 672 consecutive patients with NCCP were prospectively recruited in two EDs. NCCP, physical and mental health-related quality of life and pain-related impairment were assessed at baseline and 6 months, 1 year and 2 years after the index ED visit. RESULTS Significant reductions in the intensity and frequency of NCCP and in NCCP-related disability were observed over time, with 58.1% of patients being considered NCCP-free at the 2-year follow-up. Four trajectories of NCCP intensity were identified through latent class growth mixture modelling: Worsening Trajectory (6.8%), Persistence Trajectory (20.5%), Limited Improvement Trajectory (13.1%) and Remission Trajectory (59.5%). Physical quality of life was significantly higher in the latter two trajectories at all assessment points. Patients in the Remission Trajectory reported a better mental quality of life and a greater decrease in NCCP-related disability over time than those in the other trajectories. CONCLUSIONS Over 40% of ED patients with NCCP experienced persistent biopsychosocial morbidity that warrants further clinical attention.
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, Québec, Canada; Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada; Research Centre of the Québec Heart and Lung Institute, Québec, Québec, Canada.
| | - Clermont E Dionne
- Research Centre of the CHU de Québec-Université Laval, Québec, Québec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Québec, Canada
| | - Marie-Andrée Tremblay
- School of Psychology, Université Laval, Québec, Québec, Canada; Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada; Research Centre of the Québec Heart and Lung Institute, Québec, Québec, Canada
| | - Stéphane Turcotte
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada
| | - Richard P Fleet
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada
| | - Patrick M Archambault
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Québec, Québec, Canada; Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada; Centre de recherche universitaire sur les jeunes et les familles (CRUJeF), Québec, Québec, Canada
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Eriksson-Liebon M, Westas M, Johansson P, Mourad G. Long-term effects and predictors of change of internet-delivered cognitive behavioural therapy on cardiac anxiety in patients with non-cardiac chest pain: a randomized controlled trial. BMC Psychiatry 2024; 24:216. [PMID: 38504157 PMCID: PMC10953164 DOI: 10.1186/s12888-024-05661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Approximately half of patients who seek care at Emergency Departments due to chest pain are diagnosed with Non-Cardiac Chest Pain (NCCP). Concerns for heart disease and misinterpretation of the symptoms increase cardiac anxiety and have a negative impact on patients' lives. Psychological interventions such as internet-delivered cognitive behavioral therapy (iCBT) are effective in treating psychological conditions such as anxiety, by helping patients to learn how to manage chest pain. AIMS To evaluate the effects of a nurse-led iCBT program on cardiac anxiety and secondary outcomes, as bodily sensations, depressive symptoms, health-related quality of life and chest pain frequency in patients with NCCP at 6- and 12-month follow-up, and to explore predictors that can have impact on the effects of the iCBT program on psychological distress. METHODS A longitudinal study of a Randomized Controlled Trial (RCT) evaluating the long-term effects of an iCBT program (n = 54) in patients with NCCP, compared to psychoeducation (n = 55). The primary outcome, cardiac anxiety was measured using the Cardiac Anxiety Questionnaire (CAQ), and the secondary outcomes were measured with The Body Sensations Questionnaire (BSQ), Patient Health Questionnaire-9 (PHQ-9), The EuroQol Visual Analog Scale (EQ-VAS) and a self-developed question to measure chest pain frequency. All measurements were performed before and after the intervention, and 3, 6 and 12 months after the intervention. Linear mixed model was used to test between-group differences in primary and secondary outcomes and multiple regression analysis was used to explore factors that may have an impact on the treatment effect of iCBT on cardiac anxiety. RESULTS A total of 85% (n = 93/109) participants completed the 12-month follow-up. Mixed model analysis showed no statistically significant interaction effect of time and group between the iCBT and psychoeducation groups regarding cardiac anxiety over the 12-month follow-up. However, there was a statistically significant interaction effect of time and group (p = .009) regarding chest pain frequency favouring the iCBT group. In addition, we found a group effect in health-related quality of life (p = .03) favouring the iCBT group. The regression analysis showed that higher avoidance scores at baseline were associated with improvement in cardiac anxiety at 12-month follow-up. CONCLUSIONS Cardiac anxiety was reduced in patients with NCCP, but iCBT was not more effective than psychoeducation. Patients with a high tendency to avoid activities or situations that they believe could trigger cardiac symptoms may benefit more from psychological interventions targeting cardiac anxiety. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov NCT03336112 on 08/11/2017.
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Affiliation(s)
- Magda Eriksson-Liebon
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Department of Emergency Medicine in Norrköping, and, Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden.
| | - Mats Westas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine in Norrköping, and, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Ghassan Mourad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Zarean E, Samani ZB, Kheiri S, Torkian S. Comparing depression, anxiety, and quality of life in individuals with cardiac and non-cardiac chest pain. Front Psychiatry 2024; 14:1302715. [PMID: 38293590 PMCID: PMC10824964 DOI: 10.3389/fpsyt.2023.1302715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024] Open
Abstract
Background Psychological factors are often overlooked as potential contributors to cardiovascular disease. This study aimed to investigate the relationship between depression, anxiety, and quality of life with chest pain origin. Method This cross-sectional study was performed from 2019 to 2020 and included participants from multiple medical centers across Shahrekord, Iran. Participants were recruited through advertisements in medical centers. Participants were divided into three groups: healthy control (n = 67), chest pain with cardiac origin (CCP) (n = 70), and chest pain with non-cardiac origin (NCCP) (n = 73). Data were collected using the Beck's Anxiety scale, Beck's Depression scale, and Short-Form Health Survey questionnaires. The chi-square, exact test, t-test, Kruskal-Wallis, and logistic regression models were used for statistical analysis. All analysis was performed using SPSS 26. Results The mean scores of depression and anxiety in the NCCP group (depression = 17.03 ± 11.93, anxiety = 17.18 ± 11.37) were significantly higher than those in the CCP (depression = 9.73 ± 5.76, anxiety = 8.77 ± 5.96) and healthy (depression = 7.00 ± 7.61, anxiety = 6.18 ± 7.63) groups (p < 0.05). The mean score of quality of life in the NCCP group (54.87 ± 12.66) was significantly lower than that in the CCP (76.31 ± 12.49) and healthy (80.94 ± 15.78) groups (p < 0.05). Patients with NCCP had higher odds of having depression (adjusted OR = 4.39, 95% CI: 1.25, 15.35) and lower odds for having mental quality of life scores than the CCP and health groups, respectively (adjusted OR = 0.90, 95% CI: 0.87, 0.94). Conclusion Our findings suggest that collaboration between psychiatrists and other specialists may be necessary to improve patients' health conditions and quality of life.
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Affiliation(s)
- Elham Zarean
- Department of Psychiatry, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Bahrami Samani
- Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Soleiman Kheiri
- Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samaneh Torkian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Hamel S, Denis I, Turcotte S, Fleet R, Archambault P, Dionne CE, Foldes-Busque G. Anxiety disorders in patients with noncardiac chest pain: association with health-related quality of life and chest pain severity. Health Qual Life Outcomes 2022; 20:7. [PMID: 35012545 PMCID: PMC8751105 DOI: 10.1186/s12955-021-01912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with noncardiac chest pain (NCCP) report more severe symptoms and lowered health-related quality of life when they present with comorbid panic disorder (PD). Although generalized anxiety disorder (GAD) is the second most common psychiatric disorder in these patients, its impact on NCCP and health-related quality of life remains understudied. This study describes and prospectively compares patients with NCCP with or without PD or GAD in terms of (1) NCCP severity; and (2) the physical and mental components of health-related quality of life. METHODS A total of 915 patients with NCCP were consecutively recruited in two emergency departments. The presence of comorbid PD or GAD was assessed at baseline with the Anxiety Disorder Schedule for DSM-IV. NCCP severity at baseline and at the six-month follow-up was assessed with a structured telephone interview, and the patients completed the 12-item Short-Form Health Survey Version 2 (SF-12v2) to assess health-related quality of life at both time points. RESULTS Average NCCP severity decreased between baseline and the six-month follow-up (p < .001) and was higher in the patients with comorbid PD or GAD (p < .001) at both time points compared to those with NCCP only. However, average NCCP severity did not differ between patients with PD and those with GAD (p = 0.901). The physical component of quality of life improved over time (p = 0.016) and was significantly lower in the subset of patients with PD with or without comorbid GAD compared to the other groups (p < .001). A significant time x group interaction was found for the mental component of quality of life (p = 0.0499). GAD with or without comorbid PD was associated with a lower mental quality of life, and this effect increased at the six-month follow-up. CONCLUSIONS Comorbid PD or GAD are prospectively associated with increased chest pain severity and lowered health-related quality of life in patients with NCCP. PD appears to be mainly associated with the physical component of quality of life, while GAD has a greater association with the mental component. Knowledge of these differences could help in the management of patients with NCCP and these comorbidities.
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Affiliation(s)
- Stéphanie Hamel
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Centre de Recherche Universitaire Sur Les Jeunes Et Les Familles (CRUJeF), 2915 avenue du Bourg-Royal, Quebec, QC G1C 3S2 Canada
| | - Stéphane Turcotte
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Richard Fleet
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Patrick Archambault
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Clermont E. Dionne
- CHU de Quebec Research Centre, Saint-Sacrement Hospital, 1050, Chemin Sainte-Foy, Quebec, QC G1S 4L8 Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Quebec Heart and Lung Institute Research Centre, 2725 chemin Sainte-Foy, Quebec, QC G1V 4G5 Canada
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Work Absenteeism and Presenteeism Loss in Patients With Non-Cardiac Chest Pain. J Occup Environ Med 2018; 60:781-786. [DOI: 10.1097/jom.0000000000001363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Roche TE, Gardner G, Jack L. The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study. BMC Health Serv Res 2017; 17:445. [PMID: 28655309 PMCID: PMC5488347 DOI: 10.1186/s12913-017-2395-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities. METHODS This study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care. RESULTS The median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were demonstrated between service models. CONCLUSIONS There was a high level of adherence to clinical guidelines for the emergency nurse practitioner service model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated comparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient reported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse practitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).
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Affiliation(s)
- Tina E. Roche
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059 Australia
- Queensland University of Technology, Institute of Health and Biomedical Innovation Victoria Park Road, Victoria Park Road, Kelvin Grove, QLD 4059 Australia
- Emergency Department, Stanthorpe Health Services, PO Box 273, Stanthorpe, QLD 4380 Australia
| | - Glenn Gardner
- Queensland University of Technology, Institute of Health and Biomedical Innovation Victoria Park Road, Victoria Park Road, Kelvin Grove, QLD 4059 Australia
- Emergency Department, Stanthorpe Health Services, PO Box 273, Stanthorpe, QLD 4380 Australia
| | - Leanne Jack
- Queensland University of Technology, School of Nursing Victoria Park Road, Kelvin Grove, QLD 4059 Australia
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Zhang L, Tu L, Chen J, Song J, Bai T, Xiang XL, Wang RY, Hou XH. Health-related quality of life in gastroesophageal reflux patients with noncardiac chest pain: Emphasis on the role of psychological distress. World J Gastroenterol 2017; 23:127-134. [PMID: 28104988 PMCID: PMC5221276 DOI: 10.3748/wjg.v23.i1.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/18/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the effects of depression and anxiety on health-related quality of life (QoL) in gastroesophageal reflux disease (GERD) patients and those suffering from cardiac (CCP) and noncardiac (NCCP) chest pain in Wuhan, China.
METHODS In this cross-sectional study, a total of 358 consecutive patients with GERD were enrolled in Wuhan, China, of which 176 subjects had complaints of chest pain. Those with chest pain underwent coronary angiography and were divided into a CCP group (52 cases) and NCCP group (124 cases). Validated GERD questionnaires were completed, and the 36-item Short-Form Health Survey and Hospital Anxiety/Depression Scale were used for evaluation of QoL and psychological symptoms, respectively.
RESULTS There were similar ratios and levels of depression and anxiety in GERD with NCCP and CCP. However, the QoL was obviously lower in GERD with CCP than NCCP (48.34 ± 17.68 vs 60.21 ± 20.27, P < 0.01). In the GERD-NCCP group, rather than the GERD-CCP group, the physical and mental QoL were much poorer in subjects with depression and/or anxiety than those without anxiety or depression. Anxiety and depression had strong negative correlations with both physical and mental health in GERD-NCCP (all P < 0.01), but only a weak relationship with mental components of QoL in GERD-CCP.
CONCLUSION High levels of anxiety and depression may be more related to the poorer QoL in GERD patients with NCCP than those with CCP. This highlights the importance of evaluation and management of psychological impact for improving QoL in GERD-NCCP patients.
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Zhang L, Tu L, Chen J, Bai T, Song J, Xiang X, Wang R, Hou X. Psychological distress as a crucial determinant for quality of life in patients with noncardiac chest pain in Central China: A cross-sectional study. Medicine (Baltimore) 2016; 95:e5289. [PMID: 27861354 PMCID: PMC5120911 DOI: 10.1097/md.0000000000005289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Increased psychiatric comorbidity, predominantly anxiety and depressive symptoms, and lower quality of life (QoL) are associated with noncardiac chest pain (NCCP). We aimed to investigate the roles of anxiety and depression in the impaired QoL of NCCP patients in Central China.In this hospital-based cross-sectional study, 200 consecutive patients who complained of chest pain with normal coronary angiography were enrolled in the Department of Cardiology and Gastroenterology, Union Hospital, Wuhan, China. Meanwhile, 100 healthy controls, with age and sex-matched, were recruited. Upper gastrointestinal endoscopy was undergone and a standardized symptom questionnaire was completed in NCCP patients. Levels of anxiety and depression and QoL were assessed using locally translated and validated versions of the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short Form Health Survey (SF-36), respectively.The NCCP patients had poorer physical and mental QoL compared with the controls, and nearly half of them had anxiety (49.7%) and depression (40.1%). Those with anxiety and/or depression had lower physical (PCS) and mental (MCS) component summary score compared with those without anxiety and depression. Increased levels of anxiety and depression were associated with lower PCS (r = -0.469 and -0.523 respectively, P < 0.001) and MCS (r = -0.474 and -0.440, respectively, P < 0.001). The chest pain, heartburn, and anxiety were independent factors influence on both PCS and MCS. Moreover, psychological distress, besides directly acting on the QoL, may also mediate indirectly effects of physical symptoms on both the physical and mental QoL.We demonstrated that anxiety and depression are important determinants for the QoL of NCCP patients. Therefore, interventions should emphasize on identifying and treating the psychological impact in NCCP.
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Affiliation(s)
| | - Lei Tu
- Division of Gastroenterology
| | | | - Tao Bai
- Division of Gastroenterology
| | | | | | - Ruiyun Wang
- Division of Gerontology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Foldes-Busque G, Hamel S, Belleville G, Fleet R, Poitras J, Chauny JM, Vadeboncoeur A, Lavoie KL, Marchand A. Factors associated with pain level in non-cardiac chest pain patients with comorbid panic disorder. Biopsychosoc Med 2016; 10:30. [PMID: 27777612 PMCID: PMC5070074 DOI: 10.1186/s13030-016-0081-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background Panic disorder (PD) is highly prevalent in patients with non-cardiac chest pain (NCCP). This study aims to explore the role of psychological factors (PD intensity, anxiety sensitivity, heart-related fear, attention and avoidance) common to NCCP and PD in predicting chest pain levels in patients with both conditions. Methods This association was investigated in emergency department patients with NCCP and PD receiving either evidence-based treatment of PD or treatment as usual. Patients were assessed at baseline and 14 weeks later for post-treatment. Results Only heart-focused fear and attention for cardiac sensations independently explained a significant portion of the variance in baseline pain (n = 66). At 3 months follow-up (n = 53), changes in heart-related fear was the only factor independently associated with changes in chest pain intensity. Even in patients with PD, fear specific to cardiac sensations seems to play a central role in determining NCCP intensity. Conclusion These results suggest that the efficacy of intervention for patients with PD and comorbid NCCP could be improved by targeting heart-related fear and attention. Trial registration NCT00736346
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada ; Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada
| | - Stéphanie Hamel
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada ; Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada
| | - Geneviève Belleville
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada
| | - Richard Fleet
- Research Chair in Emergency Medicine of Laval University, University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada ; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada
| | - Julien Poitras
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada ; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada
| | - Jean-Marc Chauny
- Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada
| | - Alain Vadeboncoeur
- Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada
| | - Kim L Lavoie
- Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada ; Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada ; Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - André Marchand
- Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada ; Fernand-Séguin Research Centre, Louis-Hippolyte Lafontaine Hospital, 7331 rue Hochelaga, Montréal, Québec H1N 3V2 Canada
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Israel JI, White KS, Gervino EV. Illness perceptions, negative emotions, and pain in patients with noncardiac chest pain. J Clin Psychol Med Settings 2015; 22:77-89. [PMID: 25609578 DOI: 10.1007/s10880-015-9419-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Illness-specific cognitions are associated with outcomes in numerous health conditions, however, little is known about their role in noncardiac chest pain (NCCP). NCCP is prevalent, impairing, and associated with elevated health care utilization. Our objective was to investigate the relations between illness perceptions, emotion, and pain in a sample of 196 adult patients diagnosed with NCCP. We found that negative illness perceptions were associated with greater anxiety, depression, chest pain, and pain-related life interference while controlling for the effects of demographic and pain-related variables. These results expand current NCCP theory and may inform future treatment development.
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Affiliation(s)
- Jared I Israel
- Department of Psychology, University of Missouri-St. Louis, One University Boulevard, 325 Stadler Hall, St. Louis, MO, 63121, USA,
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Abstract
BACKGROUND Patients with unexplained chest pain are commonly revisiting an emergency department with various symptoms, but comprehensive long-term studies are lacking. METHODS A total of 150 young adults (aged 18-40 years) with unexplained chest pain who presented at an emergency unit for 16 weeks in mid-1980s were included in a prospective cohort study. An age- and sex-matched control group was randomly selected from the same area. Data were retrieved from registers that recorded death, income, education, country of birth, diagnoses, hospitalizations, outpatient visits, and medications dispensed. RESULTS Patients with unexplained acute chest pain had lower levels of education and income and were more often immigrants. Long-term mortality rates did not differ between cases (4%) and controls (5%) during 25 years of follow-up, nor were there differences in diagnosis of ischemic heart disease. Patients with unexplained acute chest pain had more outpatient visits (median, 5 versus 2; p < .0001) and had more often been hospitalized (61.6% ever versus 41.8%; p < .001) during the follow-up period. Several disorders were more common among patients 20 to 25 years later, including atrial fibrillation, esophageal/gastric disorders, chest pain, palpitations, abdominal discomfort, musculoskeletal symptoms, sleeping disturbance, and stress reactions (p values < .05). More patients had been given antihypertensives, anticoagulants, antidepressants, analgesics, and hypnotics/tranquilizers (p values < .05). CONCLUSIONS Young patients admitted to the emergency department with unexplained acute chest pain showed no increased risk of mortality or ischemic heart disease during 25 years of follow-up, but they had higher incidence of a wide range of disorders and used more medications. Early identification and preventive interventions may improve health outcomes in these patients.
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Roche TE, Gardner G, Lewis PA. Effectiveness of an emergency nurse practitioner service for adults presenting to rural hospitals with chest pain: protocol for a multicentre, longitudinal nested cohort study. BMJ Open 2015; 5:e006997. [PMID: 25678544 PMCID: PMC4330322 DOI: 10.1136/bmjopen-2014-006997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Chest pain is common in emergency department (ED) patients and represents a considerable burden for rural health services. Health services reforms to improve access to care need appropriately skilled and supported clinicians in the delivery of safe and effective care, including the use of emergency nurse practitioners (ENPs). Despite increasing use of ENPs, little is known about the safety and quality of the service in the rural ED context. The aims of this study are (1) to examine the safety and quality of the ENP service model in the provision of care in the rural environment and (2) to evaluate the effectiveness of the service in the management of patients presenting with undifferentiated chest pain. METHODS AND ANALYSIS This is the protocol for a prospective longitudinal nested cohort study to compare the effectiveness of ENP service with that of standard care. Adults presenting to three rural EDs in Queensland, Australia with a primary presenting complaint of atraumatic chest pain will be eligible for enrolment. We will measure (1) clinician's use of evidence-based guidelines (2) diagnostic accuracy of ECG interpretation for the management of patients with suspected or confirmed ACS (3) service indicators of waiting times, length-of-stay and did-not-wait rates and (4) clinician's diagnostic accuracy as measured by rates of unplanned representation within 7 days (5) satisfaction with care, (6) quality-of-life and (7) functional status. To assess these outcomes we will use a combination of measures collected from routinely collected data, medical record review and questionnaires (with 30-day follow-up). ETHICS AND DISSEMINATION Queensland Health Human Research Ethics Committee (HREC) has approved this protocol. The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences.
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Affiliation(s)
- Tina E Roche
- Stanthorpe Health Services, Emergency Department, Stanthorpe, Queensland, Australia
- School of Nursing, Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
| | - Glenn Gardner
- School of Nursing, Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
| | - Peter A Lewis
- School of Nursing, Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
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Christoph M, Christoph A, Dannemann S, Poitz D, Pfluecke C, Strasser RH, Wunderlich C, Koellner V, Ibrahim K. Mental symptoms in patients with cardiac symptoms and normal coronary arteries. Open Heart 2014; 1:e000093. [PMID: 25436115 PMCID: PMC4244439 DOI: 10.1136/openhrt-2014-000093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/19/2014] [Accepted: 08/04/2014] [Indexed: 01/25/2023] Open
Abstract
Objectives Patients with chest pain and normal coronary arteries often suffer from physical and psychological symptoms. Therefore, this study aimed to examine the incidence of mental symptoms in patients with angiographic exclusion of a coronary heart disease. Design In 253 patients with angiographic exclusion of a coronary heart disease the type and intensity of their symptoms were evaluated before and after coronary angiography. In addition, the incidence of psychopathological symptoms was quantified by standardised questionnaires such as general anxiety and depression (HADS), heart-focused anxiety (CAQ), hypochondria (Whiteley Index) and somatoform disorder (SOMS) and quality of life (SF-12). Finally, the incidence of psychological symptoms in these patients was compared to the incidence in the normal population. Results Despite the absence of a coronary artery disease, 70% of patients continue to suffer from cardiac symptoms. The incidence of general anxiety was increased by 37% in women and by 22% in men in comparison to the normal population. Heart-focused anxiety was raised by 27%. Somatoform disorder appeared 120% more often in patients after cardiac catheterisation in comparison to the normal population. In addition, the incidence of hypochondria was elevated by 68% in patients after coronary angiography compared to normal population. This increased appearance of psychological symptoms was reflected in a significantly lower quality of life (SF-12) in patients with inconspicuous coronary angiography. Conclusions Patients with cardiac symptoms and normal coronary arteries more often suffer from mental symptoms in comparison to the healthy population.
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Affiliation(s)
- Marian Christoph
- University of Dresden, Heart Centre University Hospital , Dresden , Germany
| | - Antje Christoph
- Department of Medicine III , University Hospital Dresden , Dresden , Germany
| | - Stephanie Dannemann
- Department of Psychosomatics and Psychotherapy , University Hospital Dresden , Dresden , Germany
| | - David Poitz
- University of Dresden, Heart Centre University Hospital , Dresden , Germany
| | - Christian Pfluecke
- University of Dresden, Heart Centre University Hospital , Dresden , Germany
| | - Ruth H Strasser
- University of Dresden, Heart Centre University Hospital , Dresden , Germany
| | - Carsten Wunderlich
- University of Dresden, Heart Centre University Hospital , Dresden , Germany
| | - Volker Koellner
- Department of Psychosomatic Medicine Bliestal Clinic, Homburg/Saar , Germany
| | - Karim Ibrahim
- University of Dresden, Heart Centre University Hospital , Dresden , Germany
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Park SW, Lee H, Lee HJ, Park JC, Shin SK, Lee SK, Lee YC, Kim JE. Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain. World J Gastroenterol 2013; 19:4958-4965. [PMID: 23946601 PMCID: PMC3740426 DOI: 10.3748/wjg.v19.i30.4958] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/01/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy of amitriptyline with proton pump inhibitor (PPI) for the treatment of functional chest pain (FCP).
METHODS: This was a randomized, open-label trial investigating the addition of low dose amitriptyline (10 mg at bedtime) to a conventional dose of rabeprazole (20 mg/d) (group A, n = 20) vs a double-dose of rabeprazole (20 mg twice daily) (group B, n = 20) for patients with FCP whose symptoms were refractory to PPI. The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.
RESULTS: The between-group difference in global symptom scores was statistically significant during the last week of treatment (overall mean difference; 3.75 ± 0.31 vs 4.35 ± 0.29, the between-group difference; P < 0.001). Furthermore, 70.6% of patients in group A had their symptoms improve by > 50%, whereas only 26.3% of patients in group B had a similar treatment response (70.6% vs 26.3%, P = 0.008). Specifically, patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B (52.37 ± 17.00 vs 41.32 ± 12.34, P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84, P = 0.01, respectively).
CONCLUSION: Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.
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Ford AC, Suares NC, Talley NJ. Meta-analysis: the epidemiology of noncardiac chest pain in the community. Aliment Pharmacol Ther 2011; 34:172-80. [PMID: 21615436 DOI: 10.1111/j.1365-2036.2011.04702.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prevalence of, and risk factors for, noncardiac chest pain in the community have not been well studied. AIMS To conduct a systematic review and meta-analysis to examine these issues. METHODS MEDLINE, EMBASE and EMBASE Classic were searched (up to March 2011) to identify population-based studies reporting prevalence of noncardiac chest pain in adults (≥15 years) according to self-report, questionnaire or specific symptom-based criteria. Prevalence of noncardiac chest pain was extracted for all studies, and according to study location and certain other characteristics including presence or absence of gastro-oesophageal reflux disease (GERD) symptoms, where reported. Pooled prevalence overall, as well as odds ratios (OR), with 95% confidence intervals (CIs) were calculated. RESULTS Of 18 articles evaluated, 16 reported prevalence of noncardiac chest pain in 14 separate populations, containing 24 849 subjects. Pooled prevalence of noncardiac chest pain in all studies was 13% (95% CI 9-16). The prevalence of noncardiac chest pain was higher in Australian studies and in studies using a questionnaire to define its presence, compared with those using Rome I or II criteria. Prevalence was no different in women vs. men (OR 0.99; 95% CI 0.82-1.20). The prevalence was markedly higher in subjects who also reported GERD (OR 4.71; 95% CI 3.32-6.70) and increased according to frequency of GERD symptoms. CONCLUSIONS Pooled prevalence of noncardiac chest pain in the community was 13%, but there were few studies. Rates did not appear to differ according to gender or age. Presence of GERD was strongly associated with noncardiac chest pain.
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Affiliation(s)
- A C Ford
- Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK.
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