Study: Nonspecific chest pain leads to unnecessary diagnostic testing

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Approximately half of all patients presenting with nonspecific chest pain are not provided symptom relief by way of standard medical care and every tenth patient with persistent chest pain shows signs of overinvestigation by physicians, while psychological investigations are rarely given, said a study published in the Feb. 8 issue of Archives of Internal Medicine.

Julia Glombiewski, PhD, of Philipps-University of Marburg, Germany, and colleagues designed their prospective study to relate optimum healthcare usage with nonspecific chest pain, which although common in primary care, knowledge remains sparse about its course and outcomes, said the authors.

The researchers recruited 807 patients with an average age 57.6 years presenting with non-specific chest pain-identified by an expert committee for their study. Seventy-four German primary care offices were selected by the researchers as the physician-based cohort between Oct. 1, 2005 and July 31, 2006.  Preliminary diagnoses, along with any investigations and treatments related to the patients’ chest pain was initially recorded by the physicians. The patients were contacted by phone six weeks and then again six months after the initial consultation for follow-up consultations.

At the six-month follow up consultation, the researchers found that 419 of the 755 study participants that provided data still reported experiencing persistent chest pain (55.5 percent). Forty five (10.7 percent) of this subgroup were categorized by the researchers as utilizing healthcare inappropriately, defined as two or more visits to a cardiologist or three or more cardiac diagnostic investigations in a six-month period.

In addition, Glombiewski and colleagues noted that while most patients with nonspecific chest pain were referred to a cardiologist, less than 2 percent were referred to mental health specialists.

The researchers believe that this finding in part may help explain the high prevalence of chest pain in the general population.

“Patients with psychologically caused non-specific chest pain showed more problematic healthcare–seeking behavior but were rarely referred to mental health professionals,” wrote the authors. “Patients, general practitioners or both seem to be hesitant to involve psychological interventions.”

While the authors noted that the strengths of their study included a large sample size and a small drop-out rate, Glombiewski and colleagues wrote that the definition of nonspecific chest pain was a limitation, noting more than 50 percent of patients with persistent chest pain are found to not have any underlying heart condition.

Nonspecific chest pain is not explainable by a well-established pathophysiologic condition, said the authors. “It is a frequent phenomenon in primary care.”