Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy

Kisely, Steve; Campbell, Leslie Anne; Yelland, Michael; Paydar, Anita

doi:10.1002/14651858.cd004101.pub4

Cited by 38 publications

(50 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Even though the aetiology of non-cardiac chest pain and benign palpitations is multifactorial, psychological treatments are useful [16,17]. Thus there is a need to identify patients who could benefit from such treatment.…”

Section: Introductionmentioning

confidence: 99%

Illness perception among patients with chest pain and palpitations before and after negative cardiac evaluation

Jonsbu

Martinsen

Morken

et al. 2012

BioPsychoSocial Med

View full text Add to dashboard Cite

BackgroundPatients with chest pain or palpitations often have poor outcomes following a negative cardiac evaluation, with symptom persistence, limitations in everyday activities, and reduced health-related quality of life. The aims of this study were to evaluate illness perceptions before and after negative cardiac evaluations and measure the ability of a self-report questionnaire to predict outcomes.MethodsPatients (N = 138) referred for chest pain or palpitations to a cardiac outpatient clinic were assessed before and six months after a negative cardiac evaluation. In addition to Brief Illness Perception Questionnaire (BIPQ), all patients completed the Beck Depression Inventory and SF-36 Health Survey.ResultsThe emotional reactions to and understanding of symptoms had not improved six months after a negative cardiac evaluation. A stronger correlation between illness perceptions and health at follow-up than before the cardiac evaluation might explain the tendency for poor outcomes among these patients. Most of the eight BIPQ item scores before the negative cardiac evaluation were predictive of the outcome six months later. A single question asking about the perceived consequences of the complaints (BIPQ Item 1) rated before the cardiac evaluation was collapsed into a dichotomous variable with a cut-off at ≥4 which yields a sensitivity of 51%, a specificity of 85%, a positive predictive value of 71%, a negative predictive value of 69%, and an odds ratio of 5.7 (r = .38, p < .001) in predicting poor outcomes.ConclusionsAssessing illness perceptions is important in patients with negative cardiac tests for understanding and predicting outcomes.

show abstract

Section: Introductionmentioning

confidence: 99%

Illness perception among patients with chest pain and palpitations before and after negative cardiac evaluation

Jonsbu

Martinsen

Morken

et al. 2012

BioPsychoSocial Med

View full text Add to dashboard Cite

show abstract

“…It is estimated that in half of all patients presenting with chest pain, the pain is of non-cardiac origin. 141 A high-quality review of psychological interventions for chest pain in patients with normal coronary anatomy (15 studies, 803 participants), 142 suggests a modest to moderate benefit, especially for CBT and possibly hypnotherapy. Our trial indicates that non-pharmacological intervention may also be effective for chest pain in patients with CHD.…”

Section: An Intervention For Symptomatic Coronary Heart Disease and Dmentioning

confidence: 99%

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

Tylee

Barley

Walters

et al. 2016

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundDepression is common in patients with coronary heart disease (CHD) but the relationship is uncertain. In the UK, general practitioners (GPs) have been remunerated for finding depression in CHD patients; however, it is unclear how to manage these patients.ObjectivesOur aim was to explore the relationship between CHD and depression in a GP population and to develop nurse-led personalised care (PC) for patients with CHD and depression.DesignThe UPBEAT-UK study consisted of four related studies. A cohort study of patients from CHD registers to explore the relationship between CHD and depression. A metasynthesis of relevant literature and two qualitative studies [patients’ perspectives and GP/practice nurse (PN) views on management of CHD and depression] helped develop an intervention. A pilot randomised controlled trial (RCT) of PC was conducted.SettingThirty-three GP surgeries in south London.ParticipantsAdult patients on GP CHD registers.InterventionsFrom the qualitative studies, we developed nurse-led PC, combining case management and self-management theory. Following biopsychosocial assessment, a PC plan was devised for each patient with chest pain and depressive symptoms. Nurses helped patients address their most important related problems. Use of existing resources was promoted. Nurse time was conserved through telephone follow-up.Main outcome measuresThe main outcome of the pilot study of our newly developed PC for people with depression and CHD was to assess the acceptability and feasibility of the intervention and to decide on the best outcome measures. Depression, measured by the Hospital Anxiety and Depression Scale – depression subscale, and chest pain, measured by the Rose angina questionnaire, were the main outcome measures for the feasibility and cohort studies. Cardiac outcomes in the cohort study included: attendance at rapid access chest pain clinics, stent insertion, bypass graft surgery, myocardial infarction and cardiovascular death. Service use and costs were measured and linked to quality-adjusted life-years (QALYs). Data for the pilot RCT were obtained by research assistants from patient interviews at baseline, 1, 6 and 12 months for the pilot RCT and at baseline and 6-monthly interviews for up to 36 months for the cohort study, using standard questionnaires.ResultsPersonalised care was acceptable to patients and proved feasible. The reporting of chest pain in the intervention group was half that of the control group at 6 months, and this reduction was maintained at 1 year. There was also a small improvement in self-efficacy measures in the intervention group at 12 months. Anxiety was more prevalent than depression in our CHD cohort over the 3 years. Nearly half of the cohort complained of chest pain at outset, with two-thirds of these being suggestive of angina. Baseline exertional chest pain (suggestive of angina), anxiety and depression were independent predictors of adverse cardiac outcome. Psychosocial factors predicted the continued reporting of exertional chest pain across the 3 years of follow-up. Costs were slightly lower for the PC group but QALYs were also lower. Neither difference was statistically significant.ConclusionsChest pain, anxiety, depression and social problems are common in patients on CHD registers in primary care and predict adverse cardiac outcomes. Together they pose a complex management problem for GPs and PNs. Our pilot trial of PC suggests a promising approach for treatment of these patients. Generalisation is limited because of the selection bias in recruitment of the practices and the subsequent participation rate of the CHD register patients, and the fact that the research took place in south London boroughs. Future work should explicitly explore methods for effective implementation of the intervention, including staff training needs and changes to practice.Trial registrationCurrent Controlled Trials ISRCTN21615909.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 8. See the NIHR Journals Library website for further project information.

show abstract

“…Given the lack of persistent concern for cardiac problems and acceptance of psychological factors found in the present study, brief psycho-educational interventions that draw on the principles of CBT may be useful for this group. CBT interventions have been shown to be effective for reducing psychological distress and pain in patients with NCCP (Kisely et al 2012); however, such interventions are lengthy (six to eight weeks), and therefore not amenable to acute settings. Brief interventions lend themselves to use within acute settings, where staff do not have the time to deal with patients' concerns.…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

“…Previous interventions for patients with NCCP have been centred on cognitive behavioural therapy (CBT). Although CBT has been found to be effective (Kisely et al 2012), it is typically intensive in nature, and thus difficult to deliver in an ED setting. There is therefore a need for brief psychological interventions.…”

Section: Introductionmentioning

confidence: 99%

‘Everything's fine, so why does it happen?’ A qualitative investigation of patients' perceptions of noncardiac chest pain

Webster

Thompson

Norman

2015

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectivesTo examine patients' perceptions and experiences of noncardiac chest pain, within the framework of the common sense model.BackgroundPatients with noncardiac chest pain have good physical prognosis, but frequently suffer prolonged pain and psychological distress. The common sense model may provide a good framework for examining outcomes in patients with noncardiac chest pain.DesignQualitative thematic analysis with semi‐structured interviews.MethodsIn 2010, participants recruited from an emergency department (N = 7) with persistent noncardiac chest pain and distress were interviewed using a semi‐structured schedule, and data were analysed using thematic analysis.ResultsSeven themes were identified; six of which mapped onto core dimensions of the common sense model (identity, cause, timeline, consequences, personal control, treatment control). Contrary to previous research on medically unexplained symptoms, most participants perceived psychological factors to play a causal role in their chest pain. Participants' perceptions largely mapped onto the common sense model, although there was a lack of coherence across dimensions, particularly with regard to cause.ConclusionPatients with noncardiac chest pain lack understanding with regard to their condition and may be accepting of psychological causes of their pain.Relevance to clinical practiceBrief psychological interventions aimed at improving understanding of the causes of noncardiac chest pain and providing techniques for managing pain and stress may be useful for patients with noncardiac chest pain.

show abstract

Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy

Cited by 38 publications

References 88 publications

Illness perception among patients with chest pain and palpitations before and after negative cardiac evaluation

Illness perception among patients with chest pain and palpitations before and after negative cardiac evaluation

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

‘Everything's fine, so why does it happen?’ A qualitative investigation of patients' perceptions of noncardiac chest pain

Contact Info

Product

Resources

About