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Randomized Controlled Trial
. 2009 Feb 26:338:b541.
doi: 10.1136/bmj.b541.

Information sheets for patients with acute chest pain: randomised controlled trial

Jane Arnold  1 , Steve Goodacre, Peter Bath, Jonathan Price
Affiliations
Randomized Controlled Trial

Information sheets for patients with acute chest pain: randomised controlled trial

Jane Arnold et al. BMJ. .

Abstract

Objectives: To determine whether providing an information sheet to patients with acute chest pain reduces anxiety, improves health related quality of life, improves satisfaction with care, or alters subsequent symptoms or actions.

Design: Single centre, non-blinded, randomised controlled trial.

Setting: Chest pain unit of an emergency department.

Participants: 700 consecutive patients with acute chest pain and no clear diagnosis at initial presentation.

Interventions: After a diagnostic assessment patients were randomised to receive either standard verbal advice or verbal advice followed by an information sheet.

Main outcome measures: The primary outcome was anxiety (hospital anxiety and depression scale). Secondary outcomes were depression (hospital anxiety and depression scale), health related quality of life (SF-36), patient satisfaction, presentation with further chest pain within one month, lifestyle change (smoking cessation, diet, exercise), further information sought from other sources, and planned healthcare seeking behaviour in response to further pain.

Results: 494 of 700 (70.6%) patients responded. Compared with those receiving standard verbal advice those receiving advice and an information sheet had lower mean hospital anxiety and depression scale scores for anxiety (7.61 v 8.63, difference 1.02, 95% confidence interval 0.20 to 1.84) and depression (4.14 v 5.28, difference 1.14, 0.41 to 1.86) and higher scores for mental health and perception of general health on the SF-36. The information sheet had no significant effect on satisfaction with care, subsequent symptoms, lifestyle change, information seeking, or planned actions in the event of further pain.

Conclusions: Provision of an information sheet to patients with acute chest pain can reduce anxiety and depression and improve mental health and perception of general health but does not alter satisfaction with care or other outcomes.

Trial registration: Current Controlled Trials ISRCTN85248020.

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Conflict of interest statement

Competing interests: JP has received research grants and honorariums from Servier UK.

Figures

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Patient flow through trial
See this image and copyright information in PMC

Comment in

References

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    1. Fleet RP, Dupuis G, Marchand A, Burelle D, Arsenault A, Beitman BD. Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation and physician recognition. Am J Med 1996;101:371-80. - PubMed
    1. Yingling KW, Wulsin LR, Arnold LM, Rouan GW. Estimated prevalences of panic disorder and depression among consecutive patients seen in an emergency department with acute chest pain. J Gen Intern Med 1993;8:231-5. - PubMed
    1. Goodacre S, Mason S, Arnold J, Angelini K. Psychological morbidity and health-related quality of life of patients assessed on a chest pain observation unit. Ann Emerg Med 2001;38:369-76. - PubMed
    1. Price JR, Mayou RA, Bass CM, Hames RJ, Sprigings D, Birkhead JS. Developing a rapid access chest pain clinic: qualitative studies of patients’ needs and experiences. J Psychosom Res 2005;59:237-46. - PubMed

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