Background: Chest pain is one of the most common reasons for care-seeking, but often patients are diagnosed as non-cardiac (NCCP). NCCP patients suffer from cardiac anxiety, defined as fear of cardiac-related stimuli and sensations, which is strongly associated with increased healthcare utilization. Research indicates that somatization, defined as report of somatic symptoms that have no pathophysiological cause, is a relatively common cause in chest pain patients. The prevalence of somatization in NCCP patients and its association with cardiac anxiety and healthcare utilization needs further investigation.

Purpose: To describe the prevalence of somatization and its association with cardiac anxiety and healthcare utilization in NCCP patients.

Methods: Data in this cross sectional study was collected from 552 patients diagnosed with NCCP in four Swedish hospitals within one month from discharge. Patients had a mean age of 64±17 years, and 51% were women. Somatization was measured with the Patient Health Questionnaire-15 and cardiac anxiety with the Cardiac Anxiety Questionnaire. Healthcare utilization, i.e. number of healthcare contacts the year before study inclusion was self-reported by the patients. To determine the association between somatization, cardiac anxiety and healthcare utilization, a logistic hierarchical regression analysis was used with cardiac anxiety inserted in the first block, somatization in the second block, and a variable where these two were multiplied in the third block.

Results: In total, 283 (51%) patients reported at least moderate levels of somatization and 229 (42%) patients reported cardiac anxiety. Of the total, 89 (16%) had only somatization; 88 (16%) had only cardiac anxiety; and 194 (35%) had both somatization and cardiac anxiety. Somatization was strongly related to cardiac anxiety (r=.54, p<.010). About 26% of the patients reported 2-3 healthcare contacts and 14% reported more than 3 healthcare contacts due to chest pain. Both somatization (r=.37, p<.010) and cardiac anxiety (r=.46, p<.010) were significantly related to number of healthcare contacts. The logistic hierarchical regression showed that cardiac anxiety (OR=1.09, CI=1.07-1.11, p< .001) and somatization (OR=1.08, CI=1.03-1.13, p< .001) were associated with increased healthcare utilization. The multiplicative interaction term between these variables was not significant (OR=1.09, CI=0.996-1.00, p .901).

Conclusions: Somatization was frequently reported by NCCP patients and associated with cardiac anxiety and increased healthcare contacts. Somatization may therefore be important to target with interventions.