Continuous event recorders did not affect anxiety or quality of life in patients with palpitations

Hoefman, Emmy; Boer, Kimberly R.; Weert, Henk van; Reitsma, Johannes B.; Köster, R; Bindels, Patrick J.P.

doi:10.1016/j.jclinepi.2007.01.014

Cited by 7 publications

(15 citation statements)

References 26 publications

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“…24 Heterogeneity between studies was low (I 2 = 0%). We observed a statistically insignificant increase in anxiety at longer-term follow-up in patients who underwent investigation, as shown in …”

Section: Anxietymentioning

confidence: 99%

“…25,26,29 One each involved blood tests and electrocardiography for chest pain, 32 imaging for headache, 31 and continuous event recorders for palpitations. 24 With the exception of 2 trials, 19,27 studies involved recent rather than persistent symptoms. Several studies specified a minimum duration to exclude trivial conditions for which diagnostic testing may not be clinically necessary.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…No study had clearly inadequate randomization procedures or allocation concealment, although details were unclear in 6 trials for each of these criteria. 19,24,27,29,30,32 One study used a modified Zelen preconsent randomization to minimize the risk of patients feeling more anxious about being declined a diagnostic test. 31 Most studies were of moderate quality; outcomes from those with the highest quality 23,27,31,35 did not differ noticeably from the other outcomes.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Asante et al, 28 1998 Bytzer et al, 19 1994 Cuddihy et al, 20 2005 Delaney et al, 21 2000 Duggan et al, 23 2009 Giannini et al, 30 2008 Hoefman et al, 24 2007 Howard et al, 31 2005 Kendrick et al, 25 2001 Kerry et al, 26 2002 Laheij et al, 27 1998 Delaney et al, 22 ? -R a n d o m s e q u e n c e g e n e r a t io n …”

Section: Subsequent Primary Care Visitsunclassified

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Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease

Rolfe¹,

Burton²

2013

JAMA Intern Med

152

103

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Importance: Diagnostic tests are often ordered by physicians in patients with a low pretest probability of disease to rule out conditions and reassure the patient.Objective: To study the effect of diagnostic tests on worry about illness, anxiety, symptom persistence, and subsequent use of health care resources in patients with a low pretest probability of serious illness.Evidence Acquisition: Systematic review and metaanalysis. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsychINFO, CINAHL, and ProQuest Dissertations electronic databases through December 31, 2011, for eligible randomized controlled trials. We independently identified studies for inclusion and extracted the data. Disagreements were resolved by discussion. We performed metaanalysis if heterogeneity was low or moderate (I 2 Ͻ50%).Results: Fourteen randomized controlled trials that included 3828 patients met the inclusion criteria and were analyzed with outcomes categorized as short term (Յ3 months) or long term (Ͼ3 months). Three trials showed no overall effect of diagnostic tests on illness worry (odds ratio, 0.87 [95% CI, 0.55-1.39]), and 2 showed no effect on nonspecific anxiety (standardized mean difference, 0.06 [Ϫ0.16 to 0.28]). Ten trials showed no overall long-term effect on symptom persistence (odds ratio, 0.99 [95% CI, 0.85-1.15]). Eleven trials measured subsequent primary care visits. We observed a high level of heterogeneity among trials (I 2 =80%). Meta-analysis after exclusion of outliers suggested a small reduction in visits after investigation (odds ratio, 0.77 [95% CI, 0.62-0.96]).Conclusions and Relevance: Diagnostic tests for symptoms with a low risk of serious illness do little to reassure patients, decrease their anxiety, or resolve their symptoms, although the tests may reduce further primary care visits. Further research is needed to maximize reassurance from medically necessary tests and to develop safe strategies for managing patients without testing when an abnormal result is unlikely.

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Section: Anxietymentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Subsequent Primary Care Visitsunclassified

See 2 more Smart Citations

Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease

Rolfe¹,

Burton²

2013

JAMA Intern Med

152

103

View full text Add to dashboard Cite

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“…The most common being atrial fibrillation (AF), a risk factor for stroke (Lane et al, 2013). Whatever their origin, palpitations are associated with increased anxiety and reduced quality of life (Hoefman et al 2007, Thrall et al 2006.…”

Section: Palpitationsmentioning

confidence: 99%

Using health psychology techniques to manage chronic physical symptoms

Barley

Lawson

2016

Br J Nurs

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Chest pain and palpitations, non-malignant pain, breathlessness and fatigue often endure despite the receipt of appropriate nursing and medical care. This is distressing for patients, impacts on their quality of life and ability to function and is associated with high healthcare usage and costs. The cognitive behavioural approach offers nurses a model to understand how people's perceptions and beliefs and their emotional, behavioural and physiological reactions are linked. Common 'thinking errors' which can exacerbate symptom severity and impact are highlighted. Understanding of this model may help nurses to help patients cope better with their symptoms by helping them to come up with alternative more helpful beliefs and practices. Many Improving Access to Psychological Therapy services offer support to people with chronic physical symptoms and nurses are encouraged to sign post patients to them.In this article, the authors discuss how health psychology can help nurses to help patients to manage physical symptoms which have become chronic. That is those symptoms which continue despite the patient receiving appropriate nursing and medical care. Effective management of chronic symptoms is important for the NHS since patients with such symptoms incur high healthcare costs often through frequent but avoidable use of primary and emergency care (Celano et al, 2016;Kohlmann, Gierk, Hilbert, Brähler and Löwe, 2016;Kroenke, 2014;McDaid and Park, 2015). Nurses in a variety of fields will encounter patients with chronic physical symptoms. Among the most common are nonmalignant pain, acute chest pain and palpitations, breathlessness and fatigue. These symptoms, the scale of the problem and their impact is summarized briefly below. We then discuss the dominant health psychology model for understanding chronic symptoms -the cognitive behavioural model.

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