Patients diagnosed with non-cardiac chest pain are reluctant to consider they do have heart disease. A new study shows that explaining the test results convinces patients and reduces the likelihood of future chest pain.
The research is presented at EACVI – Best of Imaging 2020, a scientific congress of the European Society of Cardiology (ESC).
Chest pain is among the most frequent causes of consults at the emergency branch. This study refers to individuals who sought medical help for chest pain and had a computed tomography (CT) examination of the coronary arteries that showed normal arteries. “Preceding studies have reported that these patients do not believe their examination results and still think they have got heart disease,” said study creator Ms Isabel Krohn, a radiographer at Haukeland University Hospital, Bergen, Norway.2
Patients with chest pain undergo several various kinds of tests to resolve the cause. In 2018, around 600 outpatients with chest pain had CT scans at Haukeland University Hospital to inspect the coronary arteries.3 These scans showed that about 200 of the 600 patients had healthy arteries – meaning no calcium deposits or narrowing of the arterial lumen. Studies in other centres have reported that chest pain has a non-cardiac origin in two-thirds of patients.4 Typical causes are indigestion or acid reflux, musculoskeletal disorders such as back pain or sore muscles between the ribs, and psychological issues like panic attacks and anxiety.
“I noticed that quite a few patients who came for a coronary CT to diagnose their chest pain had up to now undergone a coronary CT scan and other heart examinations which found no evidence of coronary disease,” said Ms. Krohn. “Provided the excellent prognostic value of coronary CT, I thought this information could be recommended to this patient group.”
The study included 92 patients with chest pain and normal results (i.e. no signal of coronary artery disease) on CT examination of the coronary arteries. The average age used to be 51 years and 63 (68%) were women. Patients were randomly allocated to the intervention or keep an eye on group. The keep an eye on group received usual care, meaning that around one week after the scans, their general practitioner or other referring doctor told them the result used to be normal.
The intervention group went through a three-part explanation with the radiographer. In the first part, participants received extended information approximately the CT examination they just went through – both orally and in a brochure written in comprehensible terms. This included the different reasons for chest pain, low probability of inaccurate results, and very low risk of a future heart attack when CT scans show healthy arteries. In the second one part, participants were shown their own calcium score images to visually fortify the message in the brochure. Lastly, the radiographer told patients their results were normal.
Both groups were followed-up at one month. Participants were asked to rate on a scale of 0 to 10 the degree to which they believed that the CT scan of their coronary arteries had found no heart disease (0 = no believe in the results; 10 = fully believe the results). Patients in the intervention group were significantly much more likely to consider the test results in comparison to those in the keep an eye on group.
Participants were also asked how ceaselessly they currently experienced chest pain throughout their most strenuous level of activity in comparison to one month ago (reasonably more ceaselessly; approximately the same; reasonably less ceaselessly; much less ceaselessly). Two-thirds (67%) of patients in the intervention group reported experiencing chest pain much less ceaselessly in comparison to 38% of patients in the keep an eye on group (p=0.042).
Ms. Krohn said it used to be important to deliver the education as a package and to personalise it. “I explained the information in the brochure and the image, and subtly asked questions to probe whether the patient understood. That made it imaginable to customise the teaching. The sessions took five to 15 minutes depending on how much explanation every patient required. I think discussing the results with patients immediately after the test also helps them to accept the results.”
She concluded: “This sort of education is likely to change into more common in years yet to come as a way of making improvements to health literacy.”
(This story has been published from a wire agency feed without modifications to the text.)
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