Chest pain is the second most common reason people go to the emergency department (ED), but most cases—about 80%—are low-risk and not related to heart problems.
In many of these cases, the real issue may be anxiety or panic disorders.
A new study led by Indiana University School of Medicine and Regenstrief Institute found that many people with low-risk chest pain might benefit more from mental health treatment than from heart-related tests.
Anxiety is common among people with low-risk chest pain. Many also suffer from other issues such as depression, stress that shows up as physical symptoms (called somatization), and post-traumatic stress disorder (PTSD).
Identifying and treating these conditions can help reduce return visits to the ED and improve patient outcomes.
Dr. Kurt Kroenke, the lead researcher, said that while many patients worry their chest pain is from heart problems, in most low-risk cases, the heart is not the cause. Instead, treating the anxiety may be more helpful.
In the study, researchers used a tool called the GAD-7 scale, developed by Dr. Kroenke, to measure anxiety. They found that over 42% of the patients had severe anxiety. About 75% of patients also showed signs of panic disorder.
The study identified two effective ways to treat anxiety in these patients:
Cognitive Behavioral Therapy (CBT): A type of talk therapy that helps people understand and manage their thoughts and feelings. It is proven to help reduce panic and fear about chest pain.
Medications: Anti-anxiety and antidepressant medicines can reduce anxiety symptoms, especially when used along with therapy.
Dr. Kroenke compared these medications to blood pressure medicine: just as medicine can lower high blood pressure, certain medicines can lower anxiety levels.
Doctors in the emergency room often reassure patients their heart is fine. But reassurance is not always enough. Offering therapies like CBT and medication can help patients feel better and avoid coming back to the ED unnecessarily.
Dr. Paul Musey, another researcher on the study, said that connecting patients with proven anxiety treatments can make a big difference in their care and quality of life.
The study is published in Academic Emergency Medicine.
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