An RCT of brief cognitive therapy versus treatment as usual in patients with non-cardiac chest pain. (15th August 2019)

• Record Type: Journal Article
• Authors: Mulder, Roger; Zarifeh, Julie; Boden, Joseph; Lacey, Cameron; Tyrer, Peter; Tyrer, Helen; Than, Martin; Troughton, Richard
• Is Part Of: International journal of cardiology. Volume 289(2019)
• Page Start: 6
• Page End: 11
• Publication Date: 2019-08-15
• Subjects: Non-cardiac chest pain -- Randomised controlled trial -- Cognitive behavioural therapy -- Emergency department; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.01.067
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Non-cardiac chest pain (NCCP) is a common reason for presenting to an emergency department (ED). Many patients re-present with similar symptoms despite reassurance. Objective: To investigate the clinical value of a brief cognitive behavioural treatment (CBT) in reducing re-presentations of patients who present with NCCP. Method: A randomised controlled trial (RCT) comparing three or four sessions of NCCP directed CBT with treatment as usual (TAU). The primary outcome measure was reducing health service use measured as re-presentations to the ED and hospitalisations for NCCP over 12 months of follow-up. Secondary outcomes were chest pain, health anxiety, depression, anxiety, quality of life and social functioning. Results: 214 patients received CBT and 210 TAU. There was no difference in ED visits or hospitalisation at three months or 12 months follow-up. Those with prior ED presentations for NCCP were significantly less likely to present with NCCP at three months follow-up but not at 12 months. Health anxiety was less at three months in those who received CBT but this effect was not present at 12 months. No other differences in secondary outcome measures were present. Conclusions: A brief CBT intervention for NCCP failed to reduce representations or improve psychological health over 12 months. We do not recommend such an intervention to unselected patients with NCCP. Patients presenting with prior episodes of NCCP obtain benefit for a three month period. Working with those patients to sustain their improvement might be worthwhile. Highlights: A brief psychological intervention for NCCP is feasible and acceptable to patients. Treatment reduces health anxiety at 3 months. Treatment reduces representation at 3 months in those with a prior history of NCCP. Focus on patients with recurrent NCCP to sustain treatment gain is worth examining.