The value of diagnostic information to patients with chest pain suggestive of coronary artery disease.
BACKGROUND
The results of diagnostic tests often have a profound impact on the way patients view their health. Decision analyses and clinical guidelines do not routinely consider this, in part because methods are not well developed for measuring the value of testing to patients.


OBJECTIVE
To measure the value of stress testing to patients with chest pain suggestive of coronary artery disease (CAD) and to improve methods for measuring the value of diagnostic information.


METHODS
The authors conducted a prospective cohort study of patients with chest pain who were referred from 44 primary care practices for treadmill testing (N = 320). Current health status, perceived life expectancy, anxiety, uncertainty, and preferences for current health states were measured before and 1 week after testing and receipt of the results. Patients also reported the diagnosis given by their physicians after testing. The authors used paired t tests to assess changes before and after testing.


RESULTS
Perceived life expectancy lengthened, anxiety decreased, and uncertainty decreased 1 week after exercise testing, compared to before (P < 0.01). For many patients, sytoms were less bothersome after testing than before. There were few changes in perceptions of current health status, as measured by the SF-36. The authors found evidence of reassurance among patients who reported that CAD had been excluded and no evidence of psychological harm among patients who reported a new CAD diagnosis.


CONCLUSIONS
Patients experienced measurable psychological benefits from noninvasive diagnostic testing for CAD. Similar measurements should be standard components of diagnostic test evaluation.
Mushlin
Alvin I
AI
Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA. aim2001@med.cornell.edu
Kern
Lisa M
LM
Paris
Mary
M
Lambert
David R
DR
Williams
Geoffrey
G
D000328:Adult; D001007:Anxiety; D001294:Attitude to Health; D002637:Chest Pain / Q000175:diagnosis* / Q000523:psychology; D003071:Cognition; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000523:psychology; D003657:Decision Making; D005080:Exercise Test / Q000191:economics / Q000523:psychology*; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D011320:Primary Health Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome