Less than half of patients with chest pain obtain symptom relief

Fewer than half of individuals who have non-specific chest pain experience relief from symptoms following standard medical care, according to a new German study. In addition, the study found that one-tenth of those with persistent chest pain undergo potentially unnecessary diagnostic testing.
Doctors investigated 807 patients with non-specific chest pain who visited 74 German primary care offices in 2005 and 2006. The clinicians recorded their preliminary diagnoses, along with any investigations and treatments related to their patients’ chest pain. Patients were contacted by phone six weeks and then six months after the initial consultation.

Among the 755 study patients who provided data at the six-month follow-up, 419 (55.5 per cent) still had chest pain.
In addition, 45 (10.7 per cent) of those were categorised as using health care in an inappropriate manner, defined as two or more visits to a cardiologist or three or more cardiac diagnostic evaluations – including angiograms and electrocardiograms – within six months. This compared with 24 (7.1 per cent) of 336 patients with remitted chest pain.
Only six patients, less than 2 per cent, were referred to mental health specialists for ongoing chest pain.
“This finding is surprising because psychological factors are known to contribute to the development of chronic pain, and psychological consultations are covered by the healthcare system in Germany,” the study’s authors wrote.
“Patients with psychologically caused non-specific chest pain showed more problematic health care–seeking behavior but were rarely referred to mental health professionals. Patients, general practitioners or both seem to be hesitant to involve psychological interventions.” The findings help explain the high prevalence of chest pain in the general population, the study’s authors added. “Future research should investigate the development of effective interventions for non-specific chest pain and their implementation within health care systems.”
Archives of Internal Medicine 2010;170:251-255