Non-cardiac chest pain: why was a brief intervention apparently ineffective?

Background. Patients who present with chest pain but have normal coronary angiography and who are told by their cardiologist that they do not have heart disease, have a poor symptomatic, psychological and quality of life outcome and remain concerned about a serious cause of their symptoms. They frequently complain they have not had enough information. The study aimed to test the effectiveness and acceptability of a brief psychological intervention based on cognitive behavioural principles. Methods. Consecutive patients with chest pain and normal angiograms were assessed and invited to take part in a randomized controlled evaluation. The intervention consisted of an individualized information and discussion session by a specially trained cardiac nurse, together with a handout and cassette providing information and advice and telephone follow-up to discuss progress, answer questions and reiterate advice. Results. The treatment proved to be unacceptable to some patients and there was no evidence of efficacy. Conclusions. Implications for the preparation of patients undergoing angiography and for the timing and delivery of information and advice following a negative result are discussed.