Non-cardiac chest pain: why was a brief intervention apparently ineffective?

Abstract

Background: Patients who present with chest pain but have normal coronary angiography and who are told by their cardiologist that they do not have heart disease, have a poor symptomatic, psychological and quality of life outcome and remain concerned about a serious cause of their symptoms. They frequently complain they have not had enough information. The study aimed to test the effectiveness and acceptability of a brief psychological intervention based on cognitive behavioural principles.

Methods: Consecutive patients with chest pain and normal angiograms were assessed and invited to take part in a randomized controlled evaluation. The intervention consisted of an individualized information and discussion session by a specially trained cardiac nurse, together with a handout and cassette providing information and advice and telephone follow-up to discuss progress, answer questions and reiterate advice.

Results: The treatment proved to be unacceptable to some patients and there was no evidence of efficacy.

Conclusions: Implications for the preparation of patients undergoing angiography and for the timing and delivery of information and advice following a negative result are discussed.