title: Prevalence and implications of severe anxiety in a prospective cohort of acute chest pain patients.
abstract: Anxiety is a common condition which can manifest with symptoms of chest discomfort. Chest discomfort is one of the most common reasons to seek emergency medical care. We hypothesize that anxiety is highly prevalent, poorly diagnosed, and poorly treated in an acute care environment. We analyzed data from a prospective registry of chest pain patients with low to intermediate likelihood of acute coronary syndrome and coronary artery disease. Scores from the General Anxiety Disorder-7 questionnaire determined the prevalence of anxiety. Differences in presentation, evaluation, and 30-day outcomes were compared for subjects with and without severe anxiety. Of the 151 included subjects, severe anxiety was observed in 15%, moderate 14%, mild 30%, and 41% had no anxiety symptoms. Subjects with severe anxiety had similar baseline characteristics, cardiac risk factors, and symptoms to those without severe anxiety, except for the current use of tobacco (50.0% vs. 18.6%; P = 0.001). Anxiety was self-reported by 54.5% of subjects with severe anxiety and 27.3% were on antianxiety medications. Hospital admission (P = 0.888) and repeated emergency department visits within 30 days (P = 0.554) were not different between the 2 groups. Anxiety is common among patients seeking emergency evaluation of chest pain. Half of patients with severe anxiety were diagnosed and roughly one quarter were medically treated. Cardiac risk factors and symptoms are not different for patients with severe anxiety; these patients warrant a similar evaluation for heart disease as those patients without anxiety.
authors: From the * Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL; and † University of Florida, Gainesville, FL.
authors: Julio
authors: J
authors: Schwarz
authors: Adesh
authors: A
authors: Prashad
authors: David E
authors: DE
authors: Winchester
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002637:Chest Pain / Q000150:complications* / Q000175:diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index