The prevalence and correlates of psychological outcomes in patients with acute non-cardiac chest pain: a systematic review

Over 40% of patients admitted to emergency departments (ED) with chest pain receive a non-cardiac diagnosis. Patients with non-cardiac chest pain (NCCP) have a good prognosis in terms of cardiac adverse events and mortality; however, they tend to have poor outcomes in terms of psychological morbidity, quality of life (QoL), further chest pain and the use of health services. In recent years there has been an increase in the use of ED-based 'rapid rule-out' protocols and the provision of dedicated chest pain units. This review sought to chart the psychological outcomes of NCCP patients who access ED-based care, and identify the correlates of poorer psychological outcomes. Twelve papers were identified reporting 10 studies. NCCP patients had similar levels of anxiety, depression, and QoL to patients who received a cardiac diagnosis for their pain, but worse levels than healthy controls. Factors associated with poorer psychological outcomes included gender, age, previous psychiatric history and certain symptoms such as fear of dying and light headedness. However, the studies were heterogeneous, with a variety of outcome measures, designs and settings. In summary, the review identifies poor psychological outcomes in NCCP patients accessing ED-based care; however, there is a need for longitudinal studies using reliable and valid measures to define further the predictors of these poor outcomes.