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Outcomes/Effectiveness Research

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Diagnostic test information often reassures patients who have chest pain suggestive of coronary artery disease

When patients experiencing chest pain suggestive of coronary artery disease (CAD) undergo treadmill stress testing to evaluate their pain, many tend to benefit psychologically. They feel less anxiety and uncertainty about their health and anticipate a longer life 1 week after testing compared with before testing. Also, for many patients, symptoms are less bothersome after testing than they were before. Apparently, even patients whose test diagnosed CAD were not harmed psychologically, according to a study supported by the Agency for Healthcare Research and Quality (HS06901).

Alvin I. Mushlin, M.D., Sc.M., of Weill Medical College of Cornell University, and his colleagues studied the reactions of 320 patients (mean age of 56) who had chest pain but no prior CAD diagnosis who were referred for treadmill testing for CAD from 44 primary care practices. The researchers assessed patients' current health status, perceived life expectancy, anxiety, uncertainty, and health state preferences before testing and 1 week after testing and receipt of test results. Most patients were white and had private insurance.

Overall, 78 percent of patients expected that they would feel less anxious after testing. Compared with how they felt before the test, after the test patients generally perceived a small decrease in physical pain (mean score 71 vs. 69, with higher scores indicating less pain) and were more likely to think that their health was better than it was 1 year ago. Perceived life expectancy increased from a mean of 23 to 24.5 years, anxiety scores decreased from a mean of 33 to 28.4, and perceived uncertainty decreased from a mean of 13.7 to 10.2. Other perceptions of current health and functional status did not appear to change.

See "The value of diagnostic information to patients with chest pain suggestive of coronary artery disease," by Dr. Mushlin, Lisa M. Kern, M.D., M.P.H., Mary Paris, M.P.H., and others in the March/April 2005 Medical Decision Making 25, pp. 149-157.

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