Article Text

Download PDFPDF
The prevalence and correlates of psychological outcomes in patients with acute non-cardiac chest pain: a systematic review
  1. Rosemary Webster1,
  2. Paul Norman1,
  3. Steve Goodacre2,
  4. Andrew Thompson3
  1. 1Department of Psychology, University of Sheffield, Sheffield, UK
  2. 2School of Health and Related Research, University of Sheffield, Sheffield, UK
  3. 3Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
  1. Correspondence to Rosemary Webster, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK; r.a.webster{at}


Over 40% of patients admitted to emergency departments (ED) with chest pain receive a non-cardiac diagnosis. Patients with non-cardiac chest pain (NCCP) have a good prognosis in terms of cardiac adverse events and mortality; however, they tend to have poor outcomes in terms of psychological morbidity, quality of life (QoL), further chest pain and the use of health services. In recent years there has been an increase in the use of ED-based ‘rapid rule-out’ protocols and the provision of dedicated chest pain units. This review sought to chart the psychological outcomes of NCCP patients who access ED-based care, and identify the correlates of poorer psychological outcomes. Twelve papers were identified reporting 10 studies. NCCP patients had similar levels of anxiety, depression, and QoL to patients who received a cardiac diagnosis for their pain, but worse levels than healthy controls. Factors associated with poorer psychological outcomes included gender, age, previous psychiatric history and certain symptoms such as fear of dying and light headedness. However, the studies were heterogeneous, with a variety of outcome measures, designs and settings. In summary, the review identifies poor psychological outcomes in NCCP patients accessing ED-based care; however, there is a need for longitudinal studies using reliable and valid measures to define further the predictors of these poor outcomes.

  • Anxiety
  • chest pain
  • cost effectiveness
  • depression
  • diagnosis
  • emergency medicine
  • psychology
  • quality of life
  • research
  • thromboembolic disease

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.