Óskilgreindir brjóstverkir sem ekki eru vegna kransæðasjúkdóma: Algengi og mögulegt meðferðarinngrip - verkefni lokið

Fréttatilkynning verkefnisstjóra

30.7.2020

Þátttakendur voru 898 manns á aldrinum 18-65 ára sem leituðu á Hjartagátt og bráðamóttöku Fossvogi vegna brjóstverkja. Niðurstöður rannsóknarinnar gefa til kynna að ótilgreindir brjóstverkir séu algengir meðal þessa sjúklingahóps á bráðadeildum Landspítala, en alls 67-72% þátttakenda höfðu ótilgreinda brjóstverki. Sjúklingar með ótilgreinda brjóstverki voru að meðaltali yngri en hjartasjúklingar en höfðu svipaða byrði líkamlegra og andlegrar vanlíðunar. Meirihluti sjúklinga með ótilgreinda brjóstkveri hafði áframhaldandi brjóstverki eftir útskrift sem tengdust andlegri vanlíðan, og þriðjungi þeirra fannst þá skorta skýringar á mögulegum orsökum brjóstverkjanna og leiðbeiningar um viðbrögð við frekari verkjum. Einungis 40% sjúklinga með ótilgreinda brjóstverki fengu upplýsingar um aðrar mögulegar orsakir brjóstverkja. Komur á bráðadeild vegna ótilgreindra brjóstverka og viðvarandi verkir eftir útskrift voru einnig algengir meðal hjartasjúklinga. Hærri tíðni koma á bráðadeild vegna ótilgreindra brjóstverkja hafði tengsl við meiri þunglyndiseinkenni og byrði líkamlegra einkenna meðal hjartasjúklinga, en meiri heilsukvíða og byrði líkamlegra einkenna meðal sjúklinga með ótilgreinda brjóstverki. Í mati á kostnaði vegna læknisþjónustu á Landspítala frá innlögn til eins árs eftir útskrift var meðaltals heildarkostnaður sjúklinga með ótilgreinda brjóstverki tæpur þriðjungur af heildarkostnaði hjartasjúklinga. Þegar kostnaður var hins vegar skoðaður með teknu tilliti til stærðarhlutafalla hvors hóps var heildarkostnaður sjúklinga með ótilgreinda brjóstverki á Landspítala 34,2 milljónir yfir eitt ár samanborið við 35,8 milljónir íslenskra króna meðal hjartasjúklinga. Með aukinni þekkingu á algengi ótilgreindra brjóstverkja á Íslandi mætti skilgreina sjúklingahóp sem hefur þörf fyrir bætta upplýsingagjöf og þverfaglegan stuðning. Á það sérstaklega við um einstaklinga með viðvarandi verkjavanda og vanlíðan eftir útskrift.

Afrakstur verkefnis

Ein birt vísindagrein í Læknablaðinu
Eitt handrit sem sent hefur verið til birtingar í Journal of Psychosomatic Research
Fjórar masters ritgerðir við Háskólann í Reykjavík og Háskóla Íslands
Ein BS ritgerð við Háskóla Íslands
Kynningar á niðurstöðum á vísindaþingum hérlendis og erlendis
Fyrirlestar fyrir starfsfólk á Landspítala

English summary:

Numerous visits to emergency medical centers every year are due to chest pain which is not caused by cardiovascular factors. Non-cardiac chest pain (NCCP) is defined by recurrent chest pain that after a clinical examination is excluded to be of a cardiac cause. NCCP symptoms can stem from various physical or psychological factors, including reflux, muscle pain or anxiety. The aim of this study was to assess the incidence of non-cardiac chest pain in Iceland, and investigate its association with psychological functioning, health-care utilization and treatment costs. Participants were 898 patients, aged 18-65 years, who were admitted with chest pain to the Cardiac Emergency Department (CED) or General Emergency Department (GED) of the National University Hospital of Iceland - Landspitali. The results of the study indicate that NCCP is highly prevalent among chest pain patients presenting to the emergency departments of Landspitali. Overall, 67-72% of participants were defined as having NCCP. These NCCP patients were on average younger than patients with Coronary Heart Disease (CHD), but had a similar burden of somatic symptom and psychological symptoms. The majority of NCCP patients had continued chest pain post discharge, which was linked with adverse mental well-being. A third of NCCP patients stated they lacked information from medical staff regarding other possible causes for their chest pain or advise how to react if the chest pain returns. Only 40% of NCCP patients stated that they had received information about alternative causes for their chest pain.

Visits to the CED due to non-cardiac chest pain, and continued chest pain post discharge, was also common among CHD patients. A higher incidence of visits to Landspitali due to non-cardiac chest pain was associated with more depression symptoms and a higher burden of somatic symptoms among CHD patients, but more anxiety and somatic symptoms among NCCP patients.

Assessments of medical costs at Landspitali over one-year post discharge showed that average total medical costs of NCCP patients were 1/3 of the average total costs of CHD patients. However, when the total costs were assessed among the total number of participants in each patient group, the total medical costs of NCCP patients over one-year were 34,2 million Icelandic kronas compared with 35,8 million Icelandic kronas among CHD patients.

By charting the prevalence of NCCP in Iceland we could identify a sizable vulnerable group of patients with specific treatment and information needs which could require a multidisciplinary approach. Improved support could be specifically beneficial for patients with continued pain post discharge due to their increased vulnerability for poor mental well-being.

Outputs from study

One scientific paper published in Læknablaðið
One manuscript submitted for publication in Journal of Psychosomatic Research
Four master thesis‘s, from the University of Iceland and University of Reykjavík
One Bachelor thesis, at the University of Iceland
Lectures and presentation of findings at international and national congresses
Lectures for staff at the Landspítali- University hospital

Heiti verkefnis: Óskilgreindir brjóstverkir sem ekki eru vegna kransæðasjúkdóma: Algengi og mögulegt meðferðarinngrip/ Prevalence of non-cardiac chest pain in Iceland: A trial for possible intervention
Verkefnisstjóri: Erla Svansdóttir, Háskóla Íslands
Tegund styrks:  Nýdoktorsstyrkur
Styrktímabil: 2015-2017
Fjárhæð styrks: 25,2 millj. kr. alls
Tilvísunarnúmer Rannís: 152207