With chest pain, need for treatment can be a matter of perspective

Chest pain is not the same for everyone. It keeps some patients from enjoying daily activities. For others, despite identical diagnoses, the pain does little to reduce their quality of life. According to a Yale study, physicians will provide patients with better care by considering that difference before recommending invasive procedures, such as angioplasty, to improve blood flow to the heart to reduce the pain.

“There can be an important discordance between a patient’s objective capacity and the patient’s quality of life,” says Harlan M. Krumholz, M.D., associate professor of medicine and of epidemiology and public health. “For an Olympic swimmer, a minor injury could be devastating, but for someone who is mostly sedentary it might be barely noticed.”

He directed the study, which was undertaken by Jennifer A. Mattera, M.P.H. ’95, director of the Center for Outcomes Research at Yale-New Haven Hospital, for her master’s thesis, along with other researchers at Yale. The investigators compared the results from patients’ diagnostic tests—exercise electrocardiogram treadmill testing and myocardial perfusion imaging—with the patients’ views of their physical functioning and general health gathered from a questionnaire. The researchers found that the test results correlated with the patients’ perceptions of their quality of life most of the time, but that in many cases patients’ perceptions of their health and physical functioning differed markedly from what the test results showed.

“It highlights the importance of talking to the patient,” says Krumholz. “We can have all these sophisticated tests, but the ultimate measure of quality of life and functioning should be understood from the patient’s own perspective. There needs to be a connection between their goals of therapy and our goals of therapy. If our therapy is intended to help them live better, then we should be sure that we are treating the patient and not just their test results.”