Abstract
Although comparative studies differentiate noncardiac chest pain (NCCP), panic disorder, and coronary artery disease (CAD), little research has examined the defining features of NCCP, such as cardiac complaints, medical utilization, and learning history. We administered self-report measures to 80 Emergency Department (ED) patients with a primary complaint of chest pain who were subsequently found to not have CAD. Forty-eight percent of the ED utilization variance was accounted for by NCCP duration, age, cardiac distress symptoms, and prior exposure to both siblings' and friends' cardiac distress symptoms. In turn, 67% of the variance in cardiac distress symptoms was explained by education, age, NCCP duration, number of illnesses, noncardiac panic symptoms, prior exposure (friends), and prior observation of others' cardiac distress. No effects emerged for gender, ethnicity, avoidance, or depression. Results suggest that beyond the effects of age and distress intensity, prior exposure to other people's cardiac distress may influence NCCP.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Aikens, J. E., and Wagner, L. I. (1999). The cost offset of primary care behavioral services. In Stout, C. E. (ed.), The Complete Guide to Managed Behavioral Healthcare, John Wiley & Sons (in press).
Aikens, J. E., Wagner, L. I., Lickerman, A. J., Chin, M. H., and Smith, A. (1998a). Primary care physician responses to a panic disorder vignette: Diagnostic suspicion levels and pharmacological management strategies. Int. J. Psychiatry Med. 28: 179-188.
Aikens, J. E., Michael, E., Levin, T., and Lowry, E. (1998b). Symptom awareness, fear, and cardiophobic cognition in noncardiac chest pain patients. Ann. Behav. Med. 20 (Suppl.) S-072.
Aikens, J. E., Wagner, L. I., Setzer, N. S., and Smith, A. (1997). Panic disorder recognition and management by primary care physicians. Ann. Behav. Med. 19 (Suppl.): S-172.
Aikens, J. E., Wagner, L. I., and Saelinger, L. J. (1999). Reduced medical utilization and costs in anxious and depressed primary care patients receiving behavioral intervention. Adv. Med. Psychother. 10: 169-178.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Author, Washington, DC.
Bass, C., and Wade, C. (1984). Chest pain with normal coronary arteries: A comparative study of psychiatric and social morbidity. Psychol. Med. 14: 51-61.
Beck, A. T., and Steer, R. A. (1987). Manual for the Revised Beck Depression Inventory, Psychological Corporation, San Antonio, TX.
Beck, J. G., Berisford, M. A., and Taegtmeyer, H. (1991). The effects of voluntary hyperventilation on patients with chest pain without coronary artery disease. Behav. Res. Ther. 29: 611-621.
Beitman, B. D., Basha, I., Flaker, G., DeRosear, L., Mukerji, V., and Lamberti, J. (1987). Non-fearful panic disorder: Panic attacks without fear. Behav. Res. Ther. 25: 487-492.
Carter, C. S., Servan-Schreiber, D., and Perlstein, W. M. (1997). Anxiety disorders and the syndrome of chest pain with normal coronary arteries: Prevalence and pathophysiology. J. Clin. Psychiatry 58: 70-75.
Cavanaugh, S., Clark, D. C., and Gibbons, R. D. (1983). Diagnosing depression in the hospitalized medically ill. Psychosomatics 24: 809-815.
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., and Williams, C. (1985). The Mobility Inventory for Agoraphobia. Behav. Res. Ther. 23: 35-44.
Chignon, J. M., Lepine, J. P., and Ades, J. (1993). Panic disorder in cardiac outpatients. Am. J. Psychiatry 150: 780-785.
Eifert, G. H. (1991). Cardiophobia: An anxiety disorder in its own right? Special Issue: Research in anxiety and fear. Behav. Change 8: 100-116.
Eifert, G. H., and Forsyth, J. P. (1996). Heart-focused and general illness fears in relation to parental medical history and separation experiences. Behav. Res. Ther. 34: 735-739.
Eifert, G. H., Hodson, S. E., Tracey, D. R., and Seville, J. L. (1996). Heart-focused anxiety, illness beliefs, and behavioral impairment: Comparing healthy heart-anxious patients with cardiac and surgical inpatients. J. Behav. Med. 19: 385-399.
Eifert, G. H., Thompson, R. N., Zvolensky, M. J., Edwards, K., Fraser, N. L., Haddad, W. J., and Davig, J. (1999). The cardiac anxiety questionnaire: Development and preliminary validity. Behav. Res. Ther.
Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., and Beitman, B. D. (1997). Detecting panic disorder in emergency department chest pain patients: A validated model to improve recognition. Ann. Behav. Med. 19: 124-131.
Katon, W. (1996). Panic disorder: Relationship to high medical utilization, unexplained physical symptoms, and medical costs. J. Clin. Psychiatry 57: 11-18.
Kopp, M. S., Litavszky, Z., and Temesvari, A. (1996). The role of dissociation between cardiorespiratory and metabolic responses in angina-like chest pain panic patients. Behav. Cognit. Psychother. 24: 235-246.
Kroenke, K., and Mangelsdorff, A. D. (1993). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. Am. J. Med. 86: 262-266.
Lavigne, J. V., Binns, H. J., Arend, R., Rosenbaum, D., Christoffel, K. K., Hayford, J. R., and Gibbons, R. D. (1998). Psychopatholo gy and health care use among preschool children: A retrospective analysis. J. Am. Acad. Child Adolesc. Psychiatry 37: 262-270.
Lucock, M. P., Morley, S., White, C., and Peake, M. D. (1997). Responses of consecutive patients to reassurance after gastroscopy: Results of self administered questionnaire survey. Br. Med. J. 315: 572-575.
Main, C. J. (1983). The Modified Somatic Perception Questionnaire (MSPQ). J. Psychosom. Res. 27: 503-514.
Pollack, M. H., Kradin, R., Otto, M. W., Worthington, J., Gould, R., Sabatino, S. A., and Rosenbaum, J. F. (1996). Prevalence of panic in patients referred for pulmonary function testing at a major medical center. Am. J. Psychiatry 153: 110-113.
Potts, S. G., and Bass, C. M. (1995). Psychological morbidity in patients with chest pain and normal or near-normal coronary arteries: A long-term follow-up study. Psychol. Med. 25: 339-347.
Tew, R., Guthrie, E. A., Creed, F. H., and Cotter, L. (1995). A long-term follow-up study of patients with ischaemic heart disease versus patients with nonspecific chest pain. J. Psychosom. Res. 39: 977-985.
Yingling, K. W., Wulsin, L. R., Arnold, L. M., and Rouan, G. W. (1993). Estimated prevalences of panic disorder and depression among consecutive patients seen in an emerency department with acute chest pain. J. Gen. Intern. Med. 8: 2135.
Rights and permissions
About this article
Cite this article
Aikens, J.E., Michael, E., Levin, T. et al. Cardiac Exposure History as a Determinant of Symptoms and Emergency Department Utilization in Noncardiac Chest Pain Patients. J Behav Med 22, 605–617 (1999). https://doi.org/10.1023/A:1018745813664
Issue Date:
DOI: https://doi.org/10.1023/A:1018745813664