Psychological Comorbidity in Patients Presenting to the Emergency Department With Low-Risk Chest Pain and Anxiety

Low-risk chest pain (LRCP) is one of the most common conditions presenting in the emergency department (ED) and is strongly associated with anxiety. The purpose of this study is to determine the prevalence of other psychological comorbidities and clinical factors associated with severe anxiety in LRCP.

Baseline data is analyzed from the PACER trial comparing the effectiveness of two telehealth interventions for LRCP patients with anxiety. Key eligibility criteria are a HEART score < 7 and either a GAD-7 anxiety score ≥ 8 or a positive PHQ screener for panic disorder. Psychological comorbidity measures included the Patient Health Questionnaire 8-item (PHQ-8) depression scale, the PHQ-14 somatization scale, the Primary Care Posttraumatic Stress Disorder Screen, the Sheehan Disability Scale, and the General Self-Efficacy Scale. Multivariable modeling is used to determine factors associated with severe anxiety.

The 375 patients had a mean age of 39.9; 70.9% were women; 62.9% were White, 32.6% Black, and 4.5% other race. The majority (75%) screened positive for panic disorder, and 42% of participants had severe anxiety (GAD-7 ≥ 15). Non-anxiety psychological comorbidity was very high; the proportion of patients exceeding scale cut points was 58% for depression, 57% for PTSD, 52% for somatization, 59% for high disability, and 31% for low self-efficacy; each was significantly associated with severe anxiety on univariable analysis. Four patient characteristics were independently associated with severe anxiety in multivariable models: odds ratios (95% CI) were 2.7 (1.5-4.9) for depression, 2.3 (1.4-3.9) for low self-efficacy, 2.1 (1.2-3.6) for low education (high school or less), and 1.8 (1.0 to 3.3) for female sex.

LRCP is accompanied not only by anxiety but also by other potentially treatable psychological comorbidities Severe anxiety is more common in individuals with depression, low self-efficacy, lower education, and possibly women.

PACER is registered in clinicaltrials.gov identifier: NCT04811521.