Emergency Department Physician Attitudes, Practices, and Needs Assessment for the Management of Patients with Chest Pain Secondary to Anxiety and Panic
poster abstractBackground
Chest pain is a common medical complaint, accounting for 7 million annual visits to US
Emergency Departments (EDs) [1]. Most research and clinical resources are focused on
the management of the life-threatening acute coronary syndrome (ACS); however,
about 80% of all patients presenting to EDs with chest pain do not have a
cardiopulmonary emergency [2-4]. Non-ACS chest pain can be caused by anxiety or a
panic disorder, and such etiologies remain undiagnosed in almost 90% of cases, and
frequently have worse outcomes [5-9].
Objective and Methods
The study objective was to assess ED physician’s attitudes, practices, and needs in
managing chest pain related to anxiety and panic. A REDCap survey of 15 Likert-style
questions was constructed using expert consensus to ensure content validity then
administered to all faculty and resident physicians in the IU Department of Emergency
Medicine (113 individuals, 65.5% response-rate).
Results
ED providers believe a significant proportion (31.5%) of patients with chest pain at low
risk for ACS are due to panic/anxiety. Providers give such patients instructions on how
to manage their panic/anxiety only 34.8% of the time, while even fewer (19.0%) make a
diagnosis of anxiety or panic disorder in their documentation. Most providers (77.0%)
would welcome a narrative to aid in discussing anxiety/panic as a cause of chest pain
and nearly all (85.1%) would find it helpful to have specific clinic information available to
aid in follow-up.
Conclusions
A significant number of ED patients with chest pain are likely due to anxiety, and a
majority of physicians report not having the resources necessary to manage these
patients. Further work to develop relevant resources would aim to improve provider
confidence in treating these patients, and would hope to improve management of
anxiety or panic as a cause of chest pain in the ED
