Sufferers with non-cardiac chest ache are reassured with transient training
Patients diagnosed with non-cardiac chest pain are reluctant to believe that they do not have heart disease. A new study shows that explaining the test results convinces patients and reduces the likelihood of future chest pain. The research will be presented at EACVI – Best of Imaging 2020, a scientific congress of the European Society of Cardiology (ESC).
Chest pain is one of the most common causes of emergency room consultations. This study pertains to people who sought medical help for chest pain and had a computed tomography (CT) scan of the coronary arteries that showed normal arteries. “Previous studies have reported that these patients do not trust their test results and still believe they have heart disease,” said study author Isabel Krohn, a radiographer at Haukeland University Hospital in Bergen, Norway.
Patients with chest pain will have different types of tests to determine the cause. In 2018, around 600 outpatients with chest pain had CT scans at Haukeland University Hospital to examine the coronary arteries. These scans showed that approximately 200 of the 600 patients had healthy arteries – meaning there was no calcium deposition 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. Typical causes are digestive disorders or acid reflux, musculoskeletal disorders such as back pain or sore muscles between the ribs, and psychological problems such as panic attacks and anxiety.
“I noticed that a number of patients who came for a coronary CT scan to diagnose their chest pain had previously had a coronary CT scan and other cardiac exams that found no evidence of coronary disease,” said Ms. Krohn. “Given the excellent prognostic value of coronary CT, I thought this information could be of benefit to this group of patients.”
The study included 92 patients with chest pain and normal (ie no evidence of coronary artery disease) outcomes on coronary artery CT scan. The mean age was 51 years and 63 (68%) were women. The patients were randomly assigned to the intervention or control group. The control group was looked after as usual, which means that about a week after the scans, the general practitioner or another referring doctor told them the result was normal.
The intervention group went through a three-part statement with the radiologist. In the first part, the participants received detailed information about the CT examination they had just undergone – both orally and in a brochure that was written in an understandable form. This included the various causes of chest pain, the low chance of inaccurate results, and the very low risk of future heart attack when CT scans show healthy arteries. In the second part, participants were shown their own calcium score images to visually reinforce the message in the brochure. Finally, the radiologist informed the patients that their results were normal.
Both groups were followed up after one month. Participants were asked to rate, on a scale of 0 to 10, how much they believed that the CT scan of their coronary arteries had not detected heart disease (0 = no confidence in the results; 10 = complete confidence in the results). Patients in the intervention group believed in the test results significantly more often than patients in the control group.
Participants were also asked how often they were currently experiencing chest pain during their most strenuous activity compared to a month ago (slightly more common; about the same; slightly less common; much less often). Two thirds (67%) of the patients in the intervention group reported having chest pain much less frequently than 38% of the patients in the control group (p = 0.042).
Ms. Krohn said it was important to offer and personalize the training as a package. “I explained the information in the booklet and picture, and asked subtly questions to see if the patient understood. This allowed the lessons to be customized. Sessions lasted five to 15 minutes, depending on how much explanation each patient needed I think discussing the results with patients immediately after the test also helps them accept the results. “
She concluded, “This type of education is likely to be used more widely in the years to come to improve health literacy.”
Calcium in arteries has been shown to increase the imminent risk of heart attack in patients
Abstract title: CT of the coronary arteries in patients with non-coronary chest pain. An educational intervention that aims to improve confidence and reduce episodes of recurrent chest pain.
Provided by the European Society of Cardiology
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