Key result
Emergency department providers estimate that 30% of patients with low-risk chest pain have anxiety as a primary cause, yet they directly communicate this belief to only 42% of these patients.
Cross-Sectional (n=409)
Emergency providers believe a significant portion of low-risk chest pain is due to anxiety but frequently fail to communicate this or provide appropriate resources, highlighting a gap in patient-centered care.
ED providers under-communicate anxiety in low-risk chest pain; hypothesis-generating for studies on barriers and communication training.
BACKGROUND: Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism. METHODS: To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique. The survey was administered to a convenience sample of ED providers attending the 2016 American College of Emergency Physicians Scientific Assembly in Las Vegas. RESULTS: Surveys were completed by 409 emergency medicine providers from 46 states and 7 countries with a wide range of years of experience and primary practice environment (academic versus community centers). Respondents estimated that 30% of patients presenting to the ED with chest pain thought to be low risk for ACS have anxiety or panic as the primary cause but they directly communicate this belief to only 42% of these patients and provide discharge instructions to 48%. Only 39% of respondents reported adequate hospital resources to ensure follow-up. Community-based providers reported more adequate follow-up for these patients than their academic center colleagues (46% vs. 34%; p = 0.015). Most providers (82%) indicated that they wanted to have referral resources available to a specific clinic for further outpatient evaluation. CONCLUSION: Emergency Department providers believe approximately 30% of patients seeking emergency care for chest pain at low risk for ACS have anxiety as a primary problem, yet fewer than half discuss this concern or provide information to help the patient manage anxiety. This highlights an opportunity for patient centered communication.
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Musey et al. (2018) conducted a cross-sectional in Anxiety-associated low risk chest pain (n=409). Provider beliefs and practices regarding anxiety was evaluated on Provider estimates of anxiety prevalence and communication practices. Emergency department providers estimate that 30% of patients with low-risk chest pain have anxiety as a primary cause, yet they directly communicate this belief to only 42% of these patients.
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