A randomised controlled trial to measure the effect of chest pain unit care upon anxiety, depression, and health-related quality of life [ISRCTN85078221].
BACKGROUND
The chest pain unit (CPU) has been developed to provide a rapid and accurate diagnostic assessment for patients attending hospital with acute, undifferentiated chest pain. We aimed to measure the effect of CPU assessment upon psychological symptoms and health-related quality of life.


METHODS
We undertook a single-centre, cluster-randomised controlled trial. Days (N = 442) were randomised in equal numbers to CPU or routine care. Patients with acute chest pain, undiagnosed by clinical assessment, ECG and chest radiograph, were recruited and followed up with self-completed questionnaires (SF-36 and HADS) at two days and one month after hospital attendance.


RESULTS
Patients receiving CPU assessment had significantly higher scores on the physical functioning (difference 5.1 points; 95% CI 1.1 to 9.0), vitality (4.6; 1.3 to 8.0), and general health (5.7; 2.3 to 9.2) dimensions of the SF-36 at two days, and significantly higher scores on all except the emotional role dimension at one month. They also had significantly lower depression scores on the HADS depression scale at two days (0.93; 0.34 to 1.51) and one month (1.0; 0.36 to 1.66). However, initially lower anxiety scores at two days (0.89; 0.21 to 1.56) were not maintained at one month (0.48; -0.26 to 1.23). CPU assessment was associated with reduced prevalence (OR 0.71; 95% CI 0.52 to 0.97) and severity (6.5 mm on 100 m visual analogue scale; 95% CI 2.2 to 10.8) of chest pain at one month, but no significant difference in the proportion of patients taking time off work (OR 0.82; 95% CI 0.54 to 1.04).


CONCLUSIONS
CPU assessment is associated with improvements in nearly all dimensions of quality of life and with reduced symptoms of depression.
Goodacre
Steve
S
Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. s.goodacre@sheffield.ac.uk
Nicholl
Jon
J
D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D010147:Pain Measurement; D017064:Process Assessment, Health Care; D011594:Psychometrics; D011788:Quality of Life; D012647:Self-Assessment; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D006113:United Kingdom