Approaches to panic attack symptoms in cardiology outpatients

Cardiologists' attitudes towards the patients with panic attack (PA) symptoms can be affected by many variables. This study was aimed to examine the practices and attitudes of cardiologists actively practicing in Turkey through an internet-based survey. An internet-based, cross-sectional, and observational survey was administered to actively practicing adult cardiologists. The sample size was calculated (minimum 135 participants). The survey draft was created by the conductor of the study and the final version of the survey items was decided by psychiatrists and cardiologists. Cronbach's alpha based on standardized items of the survey in the pilot (0.747) and final samples (0.742) was calculated. The survey, which included the characteristics on the landing page, was delivered to participants working in the Turkey via WhatsApp and Yahoo groups. All analyses were performed using IBM SPSS Statistics version 26.0. Ethical approval and informed consent was obtained. One hundred forty-five participants (87 males (60.00%) and 58 females (40.00%); 89 cardiology resident (61.37%) and 56 cardiology specialist (38.63%)) were included in the study. In patients presenting with symptoms of PA, when no cardiac/organic etiology was detected, 83 (57.24%) of the cardiologists directly referred the patients to psychiatry, while 62 (42.76%) of them started the treatment themselves. The most common symptom in patients presenting with non-cardiac PA symptoms was palpitations (86.20%). The number of cardiologists who had experience in starting escitalopram with a preliminary diagnosis of panic disorder (PD) was 50 (31.00%). Forty-three (29.7%) of cardiologists thought that antidepressants (ADs) were addictive. Thirty-five (24.1%) of cardiologists thought that ADs caused forgetfulness. According to 61 cardiologists, ADs should be used in the morning, while according to 64 cardiologists, ADs should be used in the evening. Forty-four (30.3%) cardiologists did not think benzodiazepines were addictive. The number of cardiologists who thought that patients who admitted to any physician other than cardiology with PA symptoms should be routinely referred to cardiology was 71 (49.00%). The difference between PA and PD was not known to any of the participants (n = 145). While gender had a limited effect on the findings, it was found that being cardiology specialist or not had a significant relationship with many variables. Binary logistic regression analysis was used to predict approach in the presence of non-cardiac PA symptoms and five variables (specialization status, routine echocardiogram examination, minimum usage time of ADs, association of ADs with addiction, and routine cardiology consultation by a non-cardiologist) were included given their contribution to the model (sensitivity = 86.70%, specificity = 83.90%; Beginning block - 2 Log likelihood 197.961; Block one - 2 Log likelihood 100.083^a, Cox & Snell R² = 0.491, Nagelkerke R² = 0.659; Hosmer and Lemeshow Test p value 0.254; constant p = 0.001). Non-cardiac PA symptoms are detected in approximately one sixth of those who apply to cardiology outpatient clinics, and it is recommended that cardiologists refer these patients to psychiatry to be evaluated for PD and receive appropriate treatment. PD treatment is a teamwork, and collaboration between cardiology and psychiatry is an integral part of this process.