1. Patients with non-occluded coronary arteries who experienced cardiac symptoms had significantly higher occurrence of psychological symptoms as well as lower quality of life compared to the healthy population.
2. Non-cardiac chest pain patients did not have an increased incidence of depression compared to the healthy population.
Evidence Rating Level: 2 (Good)
Study Rundown: There is a well-established link between psychological state and physiological symptoms. Chest pain is often associated with anxiety and recent studies have shown that patients with non-coronary chest pain may have a greater incidence underlying psychological disorders. To further examine this association, patients with cardiac symptoms, chest pain, dyspnea, and palpitations, but negative angiographic studies were evaluated for the presence of psychological symptoms. As compared to the healthy population, the non-coronary chest pain patients were found to have increased incidence of both general and heart-focused anxiety, hypochondrial tendencies, and somatoform disorders. These patients were also found to have significantly lower quality of life (QOL) as compared to the healthy population. Of note, significantly fewer male patients excluded for coronary artery disease evidenced depression, while there was no difference among females. Further studies are warranted to explore these findings.
Limitations of this study include possible differences in age and gender between the study and control group as well as the lack of a baseline psychiatric exam. Further, it was possible that of the 393 patients initially enrolled, the 253 patients (64%) that chose to complete the surveys were experiencing severe mental health problems. As a result, there may have been an over-estimation of the incidence of mental health symptoms. These results support possible psychological screening for patients with non-coronary cardiac symptoms and symptoms but need corroborating studies to further define the relationship.
In-Depth [retrospective cohort]: This study collected data from 253 patients with non-coronary cardiac symptoms using questionnaires including the Cardiac Anxiety Questionnaire (CAQ), Hospital Anxiety and Depression Scale (HADS), Screening for Somatoform Disorder (SOMS), and Whiteley Index (WI) to measure heart-focused anxiety, general anxiety, somatoform disorder, and hypochondrial tendencies. A 12-Item Short Health Survey (SF-12) was used to assess quality of life. Results from these questionnaires were then compared to results obtained from the healthy control group. All questionnaires with the exception of HADS, the depression scale, demonstrated an increase in the total score associated with psychological symptoms as compared to the general population. The average CAQ score difference was found to be 28% (p<0.001). HADS-Anxiety score was found to be 37% higher in females (p <0.001) and 22% higher in males (p<0.001) when compared to the healthy population. There was a 120% increase (p <0.001) in the occurrence of somatoform disorders in patients associated with non-coronary symptoms. The occurrence of hypochondrial tendencies was found to be elevated by 68% (p<0.001). The SF-12 score for QOL found a reduction of 8.8% for physical QOL and 5.8% in psychological QOL for males and 13% for physical QOL and 8% for psychological QOL in females. The HADS-depression scale showed a 22% decrease (p <0.001) in the occurrence of depression in male patients with non-coronary cardiac pain with no significant difference in between the two female groups.
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