Study Finds Noncardiac Chest Pain Patients Reassure With Brief Education

December 13, 2020 11:32 AM IST

Sophia Antipolis [France], Dec 13 (ANI): Patients diagnosed with non-cardiac chest pain are reluctant to believe they have heart disease. A new study shows that explaining the test results convinces patients and reduces the likelihood of chest pain in the future.
The research is presented at EACVI – Best of Imaging 2020, a scientific congress of the European Society of Cardiology (ESC).
Chest pain is one of the most frequent causes of emergency consultation. This study refers to people who sought medical help for chest pain and underwent a computed tomography (CT) examination of the coronary arteries that showed normal arteries. “Previous studies have reported that these patients do not trust their test results and still think they have heart disease,” said study author Isabel Krohn, a radiographer at Haukeland University Hospital, Bergen, Norway.2
Patients with chest pain undergo various types of tests to determine the cause. In 2018, around 600 outpatients with chest pain underwent CT scans at Haukeland University Hospital to examine their coronary arteries.3 These scans showed that roughly 200 of the 600 patients had healthy arteries, meaning that there are no calcium deposits or narrowing of the arterial lumen. Studies at other centers have reported that chest pain is non-cardiac in origin in two-thirds of patients.4 Typical causes are indigestion or acid reflux, musculoskeletal disorders such as back pain or pain in the muscles between the ribs, and problems psychological attacks such as panic and anxiety attacks.
“I found that several patients who had a coronary CT scan to diagnose their chest pain had previously had a coronary CT scan and other cardiac examinations that found no evidence of coronary disease,” said Ms. Krohn. “Given the excellent prognostic value of coronary CT, I thought this information could be beneficial for this group of patients.”

The study included 92 patients with chest pain and normal results (that is, no signs of coronary artery disease) on CT examination of the coronary arteries. The average age was 51 years and 63 (68%) were women. The patients were randomly assigned to the intervention or control group. The control group received usual care, which means that about a week after the scans, they were told by their general practitioner or other referring physician that the result was normal.
The intervention group went through a three-part explanation with the radiographer. In the first part, the participants received expanded information on the CT exam they had just completed, both orally and in a written brochure in understandable terms. This included the different reasons for the chest pain, the low probability of inaccurate results, and the very low risk of a future heart attack when CT scans show healthy arteries. In the second part, participants were shown their own calcium scoring images to visually strengthen the message of the brochure. Finally, the radiographer told the patients that their results were normal.
Both groups were followed up for a month. Participants were asked to rate on a scale of 0 to 10 the degree to which they believed that the CT scan of their coronary arteries had not found any heart disease (0 = lack of confidence in the results; 10 = total confidence in the results ). Patients in the intervention group were significantly more likely to believe the test results compared to those in the control group.
Participants were also asked how often they currently experienced chest pain during their most intense activity level compared to a month ago (a little more often; roughly the same; a little less often; a lot less often) . Two-thirds (67%) of the patients in the intervention group reported experiencing chest pain much less frequently compared to 38% of the patients in the control group (P = 0.042).
Ms. Krohn said it was important to offer education as a package and to personalize it. “I explained the information in the brochure and the picture, and subtly asked questions to probe if the patient understood. That made it possible to personalize the teaching. The sessions took five to 15 minutes depending on how much explanation each patient required. I think I would discuss the results with patients immediately after the test also helps them accept the results. “
She concluded: “This type of education is likely to become more common in the coming years as a way to improve health literacy.” (AND ME)