A randomised controlled trial to measure the effect of chest pain unit care upon anxiety, depression, and health-related quality of life [ISRCTN85078221].

Publisher: BioMed Central Country of Publication: England NLM ID: 101153626 Publication Model: Electronic Cited Medium: Internet ISSN: 1477-7525 (Electronic) Linking ISSN: 14777525 NLM ISO Abbreviation: Health Qual Life Outcomes Subsets: MEDLINE

Original Publication: [London] : BioMed Central, c2003-

Anxiety/*prevention & control ; Chest Pain/*psychology ; Depression/*prevention & control ; Pain Clinics/*statistics & numerical data; Adult ; Anxiety/etiology ; Chest Pain/diagnosis ; Chest Pain/etiology ; Coronary Disease/complications ; Coronary Disease/diagnosis ; Depression/etiology ; Emergency Service, Hospital/economics ; Emergency Service, Hospital/standards ; Emergency Service, Hospital/statistics & numerical data ; Humans ; Male ; Middle Aged ; Pain Clinics/economics ; Pain Clinics/standards ; Pain Measurement ; Process Assessment, Health Care ; Psychometrics ; Quality of Life ; Self-Assessment ; Sickness Impact Profile ; Surveys and Questionnaires ; United Kingdom

Background: The chest pain unit (CPU) has been developed to provide a rapid and accurate diagnostic assessment for patients attending hospital with acute, undifferentiated chest pain. We aimed to measure the effect of CPU assessment upon psychological symptoms and health-related quality of life.
Methods: We undertook a single-centre, cluster-randomised controlled trial. Days (N = 442) were randomised in equal numbers to CPU or routine care. Patients with acute chest pain, undiagnosed by clinical assessment, ECG and chest radiograph, were recruited and followed up with self-completed questionnaires (SF-36 and HADS) at two days and one month after hospital attendance.
Results: Patients receiving CPU assessment had significantly higher scores on the physical functioning (difference 5.1 points; 95% CI 1.1 to 9.0), vitality (4.6; 1.3 to 8.0), and general health (5.7; 2.3 to 9.2) dimensions of the SF-36 at two days, and significantly higher scores on all except the emotional role dimension at one month. They also had significantly lower depression scores on the HADS depression scale at two days (0.93; 0.34 to 1.51) and one month (1.0; 0.36 to 1.66). However, initially lower anxiety scores at two days (0.89; 0.21 to 1.56) were not maintained at one month (0.48; -0.26 to 1.23). CPU assessment was associated with reduced prevalence (OR 0.71; 95% CI 0.52 to 0.97) and severity (6.5 mm on 100 m visual analogue scale; 95% CI 2.2 to 10.8) of chest pain at one month, but no significant difference in the proportion of patients taking time off work (OR 0.82; 95% CI 0.54 to 1.04).
Conclusion: CPU assessment is associated with improvements in nearly all dimensions of quality of life and with reduced symptoms of depression.

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ISRCTN ISRCTN85078221

Date Created: 20040731 Date Completed: 20040923 Latest Revision: 20191210

20231215

PMC509284

10.1186/1477-7525-2-39

15283863