NONCARDIAC CHEST PAIN AND BENIGN PALPITATIONS IN THE CARDIAC CLINIC

Objectives-To assess the characteristics of consecutive patients refer red from general practice with the presenting disorder of chest pain o r palpitations, and to determine the outcome at six months and three y ears. Setting-A single consultant teaching hospital cardiac clinic rec eiving new referrals from a health district. Design-94 consecutive ref errals by general practitioners to a cardiac clinic with the presentin g disorder of chest pain or palpitations were assessed at first attend ance (research interview, cardiologists' ratings, systematic medical c ase note information), home interview six months later, and by a posta l questionnaire at three years. Outcome measures-Physical and psycholo gical symptoms, limitation of activities, satisfaction with care, and use of health care resources. Results-39 patients were given a cardiac diagnosis and 51 patients were not given a cardiac or other major phy sical diagnosis. The non-cardiac group was more likely to be young wom en, and to report other physical symptoms and previous psychiatric pro blems. The cardiac and non-cardiac groups reported progressive improve ment in presenting symptoms and disability at the six months and three year follow up, but little change in mental state. Even so, three qua rters of the noncardiac subjects described continuing limitation of ac tivities, concern about the cause of their symptoms, and dissatisfacti on with medical care. Conclusions-A substantial proportion of the cons ecutive referrals continued to describe symptoms and disability throug hout the three years after clinic attendance. Outcome was poor for tho se who had negative investigations and were reassured that they had no cardiac disorder or other serious physical finding. These results hav e implications for defining the role of psychological assessment and f or the formulation of cost effective clinical measures to (a) minimise disability associated with cardiac disorder; and (b) prevent and trea t handicaps in those without major physical diagnoses.