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Noncardiac chest pain in the emergency department: the role of cardiac history, anxiety or depression and Type D personality

Background Noncardiac chest pain is common in patients presenting to emergency departments and is frequently associated with panic disorder. This can represent a major burden for patients and the healthcare system. Little is known about the patient characteristics that increase the risk of noncardiac chest pain. We examined whether cardiac history or Type D personality was associated with panic disorder and/or depression-driven noncardiac chest pain. Methods and results Patients presenting with noncardiac chest pain to the emergency department of the University Hospital Maastricht were screened using the Hospital Anxiety and Depression Scale (HADS). Patients scoring ≥8 on the HADS subscale were invited for a psychiatric interview; a consecutive sample of patients scoring <8 on the HADS was included as a reference group. Type D personality (tendency to experience emotional distress) was assessed with the DS14. Among the 304 HADS-positive patients, 89% were diagnosed with panic disorder/depression as compared with 8% of the 106 HADS-negative patients. Previous cardiac history was not associated with psychiatric diagnosis. Type D patients reported more anxiety symptoms (12.4 ± 4.0 vs. 8.1 ± 4.9) and depression symptoms on the HADS (10.2 ± 4.7 vs. 5.8 ± 4.9) and more often had comorbid panic disorder/depression (91/157 = 58% vs. 57/253 = 23%) than non-Type D patients (P<0.0001). Type D personality (odds ratio =8.67, 95% confidence interval 4.69–16.02), younger age and male sex were independently associated with increased risk of panic disorder or depression. Type D was independently associated with comorbid panic disorder/depression (odds ratio = 14.49). Conclusion Type D personality, but not cardiac history, is independently associated with the presence of psychopathology in noncardiac chest pain. Type D is associated with a substantially increased risk of co-occurring PD/depression in these patients.