Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with
low-risk chest pain seen in the emergency department (ED). The validated Hospital
Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening
tool in this population. The objective was to determine the prevalence of abnormal
HADS-A scores in a cohort of low-risk chest pain patients and test the association
of HADS-A score with subsequent healthcare utilization and symptom recurrence. In
a single-center, prospective, observational cohort study of adult ED subjects with
low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low
anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence
was assessed by patient report, whereas ED utilization was assessed through chart
review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The
relative risk for high anxiety being associated with at least one 30-day ED return
visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased
to 9.1 (95% confidence interval 2.18 to 38.6) for 2 or more ED return visits. Occasional
chest pain recurrence was reported by more subjects in the high anxiety group, 68%
vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal
levels of anxiety. These patients were more likely to have occasional recurrence of
their chest pain and had an increased risk multiple ED return visits.
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Article info
Publication history
Published online: July 04, 2018
Accepted:
June 11,
2018
Received in revised form:
June 6,
2018
Received:
April 3,
2018
Footnotes
This study was presented in part as an oral abstract at the Society for Academic Emergency Medicine (SAEM) annual meeting in Indianapolis, Indiana from May 16 to May 18, 2018.
Funding: Indiana University Office of the Vice Chancellor for Research (Indianapolis, Indiana, USA): Developing Diverse Researchers with InVestigative Expertise (DRIVE) Award to PIM.
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