PREDICTORS OF MORTALITY AND MORBIDITY FOLLOWING ADMISSION WITH CHEST PAIN

This study aimed to identify the predictors of outcome in 102 patients following their first admission with acute chest pain. Outcome was me asured at three months by interview and at five years by questionnaire . Chest pain, change in physical activity, return to work, smoking, ps ychiatric disorder, and mortality were assessed. The principal predict ors of chest pain and smoking were previous psychiatric disorder and a diagnosis of non-specific chest pain; a previous history of psychiatr ic disorder was associated with a five-fold increase in the risk of co ntinued chest pain at five-year follow-up (95% CI = 1.1-25.0). Psychia tric disorder at five years was predicted by psychiatric disorder at a dmission (adjusted odds ratio (adj OR)= 3.2; 95% CI 1.0-11.0) and non- specific chest pain (adj OR = 7.5; 95% CI = 1.7-32.1). Mortality at fi ve-year follow-up was independently associated with older age (adj OR = 1.1; 95% CI = 1.01-1.2), an elevated Norris score (adj OR = 1.41; 95 % CI = 1.01-1.96) and a previous history of psychiatric disorder (adj OR = 5.06; 95% CI = 1.13-22.0). These findings suggest that prediction of outcome, irrespective of underlying diagnosis, requires careful as sessment of previous or current psychiatric symptoms in patients admit ted with chest pain. Early intervention with psychological treatment f or patients with nonspecific chest pain should be considered; this may also involve help to reduce smoking. The study provides further evide nce that mortality following myocardial infarction is closely linked t o psychiatric disorder, but suggests that prior psychiatric disorder m ay be more important than 'post-infarction' depression. A larger study is needed to confirm these results.