Psychosocial outcome and use of medical resources in patients with chest pain and normal or near-normal coronary arteries: a long-term follow-up study

Forty-six patients who were investigated in 1979–80 forchest pain, and found to have normal or insignificantly narrowedcoronary arteries on coronary angiography, were followed upafter a mean interval of 11.4 years. Patients were interviewedand given standardized questionnaires covering chest pain andother physical symptoms, psychiatric morbidity, and functionalcapacity. Medical records for the follow-up period were reviewed,as were death certificates and postmortem reports, where appropriate. All patients (100%) were traced to death or their current address.Four had died (11.4 year survival rate 91%), one from ischaemicheart disease. Continuing chest pain was reported by 74%, andin 16 patients (38%), chest pain was either frequent, severeor both. A poor outcome for chest pain was associated with otherphysical symptoms and increased psychiatric morbidity, whichfor the entire cohort was higher than at 1 year after angiography.Twenty-six patients (58%) had received further hospital treatmentfor chest pain, including, in six patients, further coronaryangiography. Twenty-nine survivors (71%) were taking cardiacmedication, 12 (29%) were unable to work for medical reasons,and levels of functional disability were similar to those foundin patients with myocardial infarction or angina. This study confirms the findings of previous studies with shorterfollow-up intervals. Mortality was low, but high levels of chestpain, psychological distress, and functional incapacity persistedlong after angiography. Patients reported many physical symptomsother than chest pain, and had made heavy use of medical resources.For many patients, reassurance after angiography had been ineffective,and the prognosis was poor. Early identification and effectivemanagement of such patients could offer the NHS substantialsavings.