Anxiety is Prevailing in Non-Cardiac Chest Pain Subjects, while Somatisation is Not A Comparative Study in the Emergency Department

Objective: \udThe main purpose of this study was to verify if non-cardiac chest pain (NCCP) subjects recruited in \udan Emergency Department were more anxious, depressive or burdened by somatoform symptoms as compared with \udcardiac chest pain (CCP) subjects, and with subjects without chest pain (WOCP). \udMethods: \udWe included patients with chest pain not attributable to a gastro-oesophageal reflux disorder. NCCP \udsubjects were negative at ECG examination and at troponin test at baseline and after three months. A number of \udinstruments were administered, measuring anxiety and depression (HADS), somatisation (somatisation scale of SCL-\ud90, TAS-20), and the health-related QoL (SF-12), along with other scales measuring the social and experiential profile.\udResults: \udWe recruited 435 subjects (of which NCCP were 44.8%) in the Emergency Department, while other 147 \udsubjects were recruited in a primary care clinic. The logistic regression showed that the levels of HADS anxiety in \udthe three groups were dissimilar, even when adjusted for confounding variables: taking NCCP as reference category, \udadjusted ORs were 0.64 for CCP (IC95% 0.42 – 0.96) and 0.23 for WOCP (IC95% 0.13 – 0.40). When considering the \udsomatisation construct, CCP and NCCP subjects reported similar somatic symptom complaints, higher than WOCP \udsubjects. Moreover, even if NCCP subjects showed higher TAS-20 scores than WOCP subjects, these scores were \udbelow the range of a possible alexithymia. As for the physical health-related QoL (SF-12, subscale PCS-12), regression \udanalyses showed that the PCS-12 mean score of NCCP was higher than that of CCP (ß -2.31; IC95% -4.14 to -0.48) \udand lower than that of WOCP (ß 2.24; IC95% 0.12 – 4.37). \udConclusion\ud: NCCP subjects are characterised from an elevated anxiety, together with a better physical well-being, \udwhen compared with subjects who have a cardiac failure. The somatisation construct seems less useful to distinguish \udNCCP from CCP subjects. Consequently, anxiety should be the major target of our mental-health intervention when \udtreating subjects with chest pain