Chest anxiety
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Understanding Chest Anxiety: Insights from Recent Research
Prevalence of Anxiety in Chest Pain Patients
Anxiety is a prevalent condition among patients presenting with chest pain, often leading to emergency medical care. Studies have shown that anxiety disorders are common in this population, with a significant portion of patients experiencing severe anxiety symptoms. For instance, in a prospective cohort study, 15% of chest pain patients were found to have severe anxiety, while 14% had moderate anxiety, and 30% had mild anxiety. Additionally, anxiety was identified in 30% to 40% of patients with low-risk chest pain in the emergency department.
Anxiety as a Consequence of Chest Pain
Research indicates that chest pain can significantly increase the risk of developing anxiety and depression. A study involving patients with coronary heart disease (CHD) found that chest pain predicted more severe anxiety and depression symptoms over a 30-month period. This suggests that chest pain is a substantial contributor to psychological distress in these patients.
Diagnostic and Treatment Challenges
Despite the high prevalence of anxiety among chest pain patients, it is often underdiagnosed and undertreated. In a study of acute chest pain patients, only half of those with severe anxiety were diagnosed, and roughly a quarter were receiving antianxiety medications. This highlights a critical gap in the management of anxiety in patients presenting with chest pain.
Effective Treatment Options
Several treatment options have been explored for managing anxiety in chest pain patients. The PACER trial is a notable study that aims to compare the effectiveness of different anxiety treatments, including primary care referral with enhanced care coordination, online self-administered cognitive behavioral therapy (CBT) with peer support, and therapist-administered CBT. Early findings suggest that CBT, particularly when focused on reducing heart-focused anxiety, is effective in reducing noncardiac chest pain (NCCP) and associated anxiety symptoms.
Heart-Focused Anxiety
Heart-focused anxiety (HFA) is a specific type of anxiety characterized by a fear of cardiac sensations and worries about physical health catastrophes. It is particularly prevalent among patients with NCCP. The Cardiac Anxiety Questionnaire (CAQ) has been validated as a useful tool for assessing HFA in these patients, with a four-factor model including fear of cardiac sensations, avoidance of activities that elicit cardiac sensations, heart-focused attention, and reassurance seeking.
Implications for Emergency Department Recidivism
Anxiety has been associated with increased emergency department (ED) recidivism among patients with low-risk chest pain. Patients with high anxiety levels were found to have a higher likelihood of returning to the ED within 30 days, with a relative risk of 2.6 for at least one return visit and 9.1 for two or more return visits. This underscores the importance of addressing anxiety to reduce healthcare utilization and improve patient outcomes.
Conclusion
Anxiety is a significant and often underrecognized issue among patients presenting with chest pain. Effective management strategies, particularly those involving cognitive-behavioral interventions, are crucial for reducing anxiety symptoms and improving overall patient outcomes. Further research and clinical trials, such as the PACER study, will continue to inform best practices for treating anxiety in this population.
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