Roger Mulder1, Julie Zarifeh2, Joseph Boden2, Cameron Lacey3, Peter Tyrer4, Helen Tyrer4, Martin Than5, Richard Troughton6. 1. Department of Psychological Medicine, University of Otago, Christchurch, New Zealand. Electronic address: roger.mulder@otago.ac.nz. 2. Department of Psychological Medicine, University of Otago, Christchurch, New Zealand. 3. Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Maori Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand. 4. Centre for Mental Health, Imperial College, London, UK. 5. Canterbury District Health Board, Christchurch, New Zealand. 6. Department of Medicine, University of Otago, Christchurch, New Zealand.
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 ofNCCP obtain benefit for a three month period. Working with those patients to sustain their improvement might be worthwhile.
RCT Entities:
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.
Authors: Terje Thesen; Joseph A Himle; Egil W Martinsen; Liv T Walseth; Frode Thorup; Frode Gallefoss; Egil Jonsbu Journal: J Med Internet Res Date: 2022-01-24 Impact factor: 5.428