A Care Management Intervention for Non-cardiac Chest Pain

The investigators developed and implemented an eight-week multicomponent care management intervention for non-cardiac chest pain. The care management team consisted of a nurse, cardiologist, and psychiatrist. Following a one-time consultation visit with the cardiologist and nurse, evaluation and treatment recommendations were conveyed to the participant's primary care physician. Then, the nurse completed eight weekly phone calls with the participant to provide support, introduce therapeutic principles, and assist with coordination of care, under the supervision of a psychiatrist. Intervention feasibility was assessed on several domains including adherence, recruitment, attrition, safety, and data collection. To examine preliminary efficacy, participants completed Likert scales of chest pain symptom severity, frequency and impact, and measures of psychological health (Patient Health Questionnaire-9, General Anxiety Disorder-7, Patient Health Questionnaire-15) and health-related quality of life (12-Item Short Form Survey) at baseline and intervention completion.

Inclusion criteria

• Diagnosis of non-cardiac chest pain, defined as chest pain recurring at least once per week for two weeks with at least two of the following objective tests: (1) electrocardiogram without ischemic changes; (2) negative cardiac enzymes; (3) non-ischemic cardiac stress test.
• Primary care physician affiliated with the institution

Exclusion criteria

• History or subsequent diagnosis of cardiac disease
• Objectively diagnosed alternative medical etiology of chest pain (e.g., gastroesophageal disease)
• Resolution of chest pain prior to enrollment
• Cognitive impairment, assessed using a six-item screen
• Inability to communicate in English
• Lack of telephone access (precluding weekly phone call participation).