Can low intensity cognitive behavioural therapy for non-cardiac chest pain presentations to an emergency department be efficacious? A pilot study

Objective: Complaints of chest pain are one of the most common reasons that people visit emergency departments (EDs). However, more than 50% of patients who present to EDs with chest pain do not have identifiable cardiac disease or other medical conditions. A pilot study was conducted to investigate if using low-intensity (LI) cognitive behavioural therapy (CBT) in the ED at Flinders Medical Centre, South Australia, reduced the reported levels of anxiety and depression, re-presentation rates, and the associated cost of patients presenting to the ED with non-cardiac chest pain.

Method: A convenience sample (n = 35) was recruited from people who presented to the ED with non-cardiac chest pain and screened positive for psychological distress. If eligible, participants were referred to the Improving Access to Psychological Therapies@Flinders (IAPT@Flinders) service and, following completion, hospital medical records were reviewed to investigate the number of presentations to the ED and the subsequent costs of each presentation, in the 3 months prior and 3 months preceding treatment.

Results: There was a decrease in self-reported levels of depression and anxiety after the completion of treatment, and a suggested 59% decrease in ED admissions and a 69% cost saving.

Conclusions: The potential health benefits and cost savings as a result of LICBT for patients who present to ED's with non-cardiac chest pain warrant further investigation utilising a robust and economically validated trial.