Psychologic morbidity and health-related quality of life of patients assessed in a chest pain observation unit

Abstract

Study objectives: We sought to measure psychologic morbidity and health-related quality of life among patients attending the hospital with acute chest pain both at presentation and 1 month after rigorous assessment for cardiac disease.

Methods: Consecutive patients undergoing assessment on the chest pain observation unit of a large, urban emergency department were asked to complete 3 questionnaires: the Short Form-36 Health Survey (SF-36), the Euroqol Health Utility Questionnaire, and the Hospital Anxiety and Depression Scale. The same questionnaires were mailed 1 month later, along with a questionnaire documenting subsequent pain and reassurance.

Results: At enrollment (n=166), 32 (19%) participants (95% confidence interval [CI] 15% to 26%) were experiencing moderate levels of anxiety, and 21 (13%, 95% CI 8% to 19%) were experiencing moderate levels of depression. Health utility and all SF-36 dimensions of quality of life were substantially below age-adjusted normal values. One month after assessment (n=110), only the Pain dimension score of SF-36 had significantly improved. Most scores were unchanged, and the Physical Role and Mental Health dimension scores of SF-36 had significantly deteriorated. Seventy (64%) patients (95% CI 54% to 72%) had further pain after discharge. Despite these findings, 98 (86%) patients (95% CI 78% to 91%) responded that their assessment was "completely reassuring" or "quite reassuring."

Conclusion: Patients with acute, undifferentiated chest pain have substantial psychologic morbidity and impairment of quality of life. Although patients respond that they are reassured by chest pain observation unit assessment, anxiety and depression remain prevalent and quality of life remains impaired 1 month after assessment.