Objective: To explore and model the associations between somatization, fear of body sensations, cardiac anxiety, depressive symptoms, and healthcare use in patients with NCCP with or without history of cardiac disease (CD). Methods: Data was collected in 552 NCCP patients (mean age 64±17 years, 51% women) within one month from discharge using the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, and Patient Health Questionnaire-9. Structural Equation Modelling analyses were used to explore the relationships between somatization, fear of body sensations, cardiac anxiety, depressive symptoms and healthcare use in NCCP patients with or without history of CD.

Results: 34% of the NCCP patients had a previous diagnosis of CD. Patients with NCCP and a history of CD were mainly males, older (71 vs. 60 years), had more co-morbidities (4.7 vs. 2.8), and reported significantly higher scores in somatization (p=0.007), cardiac anxiety (p<0.001), and depressive symptoms (p=0.002), and greater healthcare use (p<0.001).

In both groups, depressive symptoms were not directly associated with healthcare use (Chi-Square=75.94, df=10, p<0.001: RMSEA=0.110: and CFI=0.95). The impact of depressive symptoms on healthcare use was mainly mediated by somatization, fear of body sensations, and cardiac anxiety (Chi-Square=9.69, df=10, p=0.47, RMSEA=0.000, and CFI=0.99), but the effects were significantly weaker in patients with no history of CD (Chi-Square=4.25, df=7, p=0.75, RMSEA=0.000, and CFI=0.99). Additionally, the direct and indirect effects between depressive symptoms, somatization, fear of body sensations, cardiac anxiety, and healthcare use were significantly stronger in patients with a history of CD. Finally, the direct effects of depressive symptoms on cardiac anxiety were about the same in both groups.

Conclusions: The associations between psychological distress and healthcare use were similar for all patients, although the effects were significantly stronger in patients with a history of CD. In both groups, depressive symptoms had no direct association with healthcare use.