Psychosocial outcome and use of medical resources in patients with chest pain and normal or near-normal coronary arteries: a long-term follow-up study

Abstract

Forty-six patients who were investigated in 1979-80 for chest pain, and found to have normal or insignificantly narrowed coronary arteries on coronary angiography, were followed up after a mean interval of 11.4 years. Patients were interviewed and given standardized questionnaires covering chest pain and other physical symptoms, psychiatric morbidity, and functional capacity. Medical records for the follow-up period were reviewed, as were death certificates and post-mortem reports, where appropriate. All patients (100%) were traced to death or their current address. Four had died (11.4 year survival rate 91%), one from ischaemic heart disease. Continuing chest pain was reported by 74%, and in 16 patients (38%), chest pain was either frequent, severe or both. A poor outcome for chest pain was associated with other physical symptoms and increased psychiatric morbidity, which for the entire cohort was higher than at 1 year after angiography. Twenty-six patients (58%) had received further hospital treatment for chest pain, including, in six patients, further coronary angiography. Twenty-nine survivors (71%) were taking cardiac medication, 12 (29%) were unable to work for medical reasons, and levels of functional disability were similar to those found in patients with myocardial infarction or angina. This study confirms the findings of previous studies with shorter follow-up intervals. Mortality was low, but high levels of chest pain, psychological distress, and functional incapacity persisted long after angiography. Patients reported many physical symptoms other than chest pain, and had made heavy use of medical resources. For many patients, reassurance after angiography had been ineffective, and the prognosis was poor. Early identification and effective management of such patients could offer the NHS substantial savings.