Results of a prospective cohort study found depression to be an independent predictor of recurrent chest pain (RCP) regardless of significant cardiac ischemia on stress testing.

During the study, a total of 985 patients with low- to moderate-cardiac risk who presented to the Yale Chest Pain Center with acute chest pain were screened. Screening scales including the Patient Health Questionnaire (PHQ8), Clinical Anxiety Scale (CAS), and Perceived Stress Scale (PSS) were utilized to assess each patient for depression, anxiety, and perceived stressed. Cardiac stress testing was performed in any patient ruled out for infarction. The primary outcome of the study was RCP at 30 days, which was assessed by phone follow-up as well as evaluation of the patient’s medical record. The study authors noted, “Depression (PHQ8 ≥10), anxiety (CAS ≥30), and perceived stress (PSS ≥15) were considered positive.” 

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Of the 500 patients who were enrolled in the study, 483 had complete data and 365 had completed follow-up. Results of the study found that within 1 month, 36% of patients (n=131) had RCP. “On multivariable regression models, depression (odds ratio [OR] = 2.11, 95% CI, 1.18–3.79) was a significant independent predictor of 30-day chest pain recurrence after adjustment, whereas PSS (OR=0.96, 95% CI, 0.60–1.53) and anxiety (OR=1.59, 95% CI, 0.80–3.20) were not,” the study authors stated. Additionally, a direct relationship between depression, which was assessed via PHQ8, and chest pain frequency was observed.

Results of this analysis found an independent association between depression and RCP. “Identification and targeted interventions may curtail recidivism with RCP,” the study authors concluded. 

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