A prospective investigation of the prognosis of noncardiac chest pain in emergency department patients

• Published in: Journal of psychosomatic research 2024-11, Vol.186, p.111883, Article 111883
• Main Authors: Foldes-Busque, Guillaume, Dionne, Clermont E., Tremblay, Marie-Andrée, Turcotte, Stéphane, Fleet, Richard P., Archambault, Patrick M., Denis, Isabelle
• Format: Article
• Language: English
• Subjects: Adult; Aged; Chest pain; Chest Pain - diagnosis; Chest Pain - psychology; Cohort Studies; Disabled Persons - psychology; Emergency care; Emergency Service, Hospital - statistics & numerical data; Female; Follow-Up Studies; Humans; Latent Class Analysis; Male; Middle Aged; Noncardiac chest pain; Pain; Patient Selection; Prognosis; Quality of Life; Somatic symptom
• ISSN: 0022-3999; 1879-1360; 1879-1360
• DOI: 10.1016/j.jpsychores.2024.111883

This study sought to describe the 2-year evolution of the intensity and frequency of noncardiac chest pain (NCCP), NCCP-related disability and health-related quality of life in a cohort of emergency department (ED) patients. It also aimed to identify and characterize subgroups of patients who share similar NCCP trajectories. 672 consecutive patients with NCCP were prospectively recruited in two EDs. NCCP, physical and mental health-related quality of life and pain-related impairment were assessed at baseline and 6 months, 1 year and 2 years after the index ED visit. Significant reductions in the intensity and frequency of NCCP and in NCCP-related disability were observed over time, with 58.1% of patients being considered NCCP-free at the 2-year follow-up. Four trajectories of NCCP intensity were identified through latent class growth mixture modelling: Worsening Trajectory (6.8%), Persistence Trajectory (20.5%), Limited Improvement Trajectory (13.1%) and Remission Trajectory (59.5%). Physical quality of life was significantly higher in the latter two trajectories at all assessment points. Patients in the Remission Trajectory reported a better mental quality of life and a greater decrease in NCCP-related disability over time than those in the other trajectories. Over 40% of ED patients with NCCP experienced persistent biopsychosocial morbidity that warrants further clinical attention. •At the cohort level, the prognosis of ED patients with NCCP appears favorable.•Patients-centered analyses revealed an heterogenous prognosis of NCCP.•Over 40% of patients with NCCP experienced an unfavorable prognosis.