Patients with non-cardiac chest pain are reassured with brief education

December 12, 2020

Sophia Antipolis - 12 December 2020: Patients diagnosed with non-cardiac chest pain are reluctant to believe 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 is presented at EACVI - Best of Imaging 2020, a scientific congress of the European Society of Cardiology (ESC).1

Chest pain is one of the most frequent causes of consults at the emergency department. This study refers to individuals who sought medical help for chest pain and had a computed tomography (CT) examination of the coronary arteries that showed normal arteries. "Previous studies have reported that these patients do not trust their examination results and still think they have heart disease," said study author Ms. Isabel Krohn, a radiographer at Haukeland University Hospital, Bergen, Norway.2

Patients with chest pain undergo several 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.3 These scans showed that approximately 200 of the 600 patients had healthy arteries - meaning no calcium deposits or narrowing of the arterial lumen. Studies in other centres have reported that chest pain has a non-cardiac origin in two-thirds of patients.4 Typical causes are indigestion or acid reflux, musculoskeletal disorders such as back pain or sore muscles between the ribs, and psychological issues like panic attacks and anxiety.

"I noticed that a number of patients who came for a coronary CT to diagnose their chest pain had previously undergone a coronary CT scan and other heart examinations which found no evidence of coronary disease," said Ms. Krohn. "Given the excellent prognostic value of coronary CT, I thought this information could be beneficial to this patient group."

The study included 92 patients with chest pain and normal results (i.e. no sign of coronary artery disease) on CT examination of the coronary arteries. The average age was 51 years and 63 (68%) were women. Patients were randomly allocated to the intervention or control group. The control group received usual care, meaning that around one week after the scans, their general practitioner or other referring doctor told them the result was normal.

The intervention group went through a three-part explanation with the radiographer. In the first part, participants received extended information about the CT examination they just went through - both orally and in a brochure written in understandable terms. This included the different reasons for chest pain, low probability of inaccurate results, and very low risk of a future heart attack when CT scans show healthy arteries. In the second part, participants were shown their own calcium score images to visually strengthen the message in the brochure. Lastly, the radiographer told patients their results were normal.

Both groups were followed-up at one 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 found no heart disease (0 = no trust in the results; 10 = fully trust 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 strenuous level of activity compared to one month ago (slightly more often; about the same; slightly less often; much less often). Two-thirds (67%) of patients in the intervention group reported experiencing chest pain much less often compared to 38% of patients in the control group (p=0.042).

Ms. Krohn said it was important to deliver the education as a package and to personalise it. "I explained the information in the brochure and the image, and subtly asked questions to probe if the patient understood. That made it possible to customise the teaching. The sessions took five to 15 minutes depending on how much explanation each patient required. I think discussing the results with patients immediately after the test also helps them to accept the results."

She concluded: "This type of education is likely to become more common in years to come as a way of improving health literacy."
ESC Press Office
Tel: +33 (0)4 89 87 20 85
Mobile: +33 (0)7 8531 2036

Follow us on Twitter @ESCardioNews

Notes to editor

Funding: None.

Disclosures: None.

References and notes
  1. Abstract title: CT of the coronary arteries in patients with noncoronary chest pain. An educational intervention aimed at improving reliance and reducing episodes of recurring chest pain.
  2. Kisely_SR, Campbell_LA, Yelland_MJ, et al. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev. 2015;6:CD004101.
  3. A CT of the coronary arteries in this centre consists of two parts: one image series showing calcium deposits in the coronary artery wall (calcium score), followed by one image series showing contrast enhanced coronary arteries (coronary CT angiography).
  4. Bjørnsen LP, Naess-Pleym LE, Dale J, et al. Description of chest pain patients in a Norwegian emergency department. Scand Cardiovasc J. 2019;53(1):28-34.

EACVI - Best of Imaging 2020
EACVI - Best of Imaging 2020 is the first online event covering the full spectrum of cardiac imaging: echocardiography, cardiovascular magnetic resonance, nuclear cardiology and cardiac computed tomography. It is organised by the European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology (ESC). It takes place online during 11 and 12 December.

About the European Association of Cardiovascular Imaging (EACVI)

The European Association of Cardiovascular Imaging (EACVI) - a branch of the ESC - is the world leading network of Cardiovascular Imaging (CVI) bringing together experts from all techniques: Echocardiography, Cardiovascular Magnetic Resonance, Nuclear Cardiology and Cardiac Computed Tomography.

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

European Society of Cardiology

Related Heart Disease Articles from Brightsurf:

Cellular pathway of genetic heart disease similar to neurodegenerative disease
Research on a genetic heart disease has uncovered a new and unexpected mechanism for heart failure.

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.

With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.

Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.

Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.

New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.

Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.

Read More: Heart Disease News and Heart Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to