Child and Caretaker Anxiety Around Pediatric Chest Pain: A Case for Cardiac Evaluation Using a Standardized Protocol

Area of Science:

• Pediatric Cardiology
• Clinical Anxiety Research

Background:

• Chest pain (CP) in young people is common but usually benign, rarely indicating cardiac issues.
• Despite the low incidence of cardiac causes, patient and family anxiety regarding pediatric CP is often significant.

Purpose of the Study:

• To assess anxiety changes in pediatric patients and their parents/caretakers after a cardiology visit for CP.
• To evaluate the correlation between post-visit anxiety, the number of cardiac tests performed, and the likelihood of unplanned return visits.

Main Methods:

• Patients aged 7-21 years evaluated for CP from 2010-2014 and their parents/caretakers rated anxiety (1-5 scale) pre- and post-visit.
• A standardized protocol guided CP assessment, with cardiac testing at provider discretion.
• Anxiety scores, cardiac test numbers, and return visit rates were analyzed.

Main Results:

• Mean pre-visit anxiety scores were 2.6 (patient) and 3.0 (parent/caretaker), decreasing to 1.3 post-visit (p < 0.0001).
• Increased cardiac testing correlated with higher post-visit anxiety in both patients (OR=1.9) and parents/caretakers (OR=1.8) (p < 0.0001).
• Higher post-visit parent/caretaker anxiety increased the likelihood of unplanned return visits (OR=2.88, p < 0.0001).

Conclusions:

• While a cardiac etiology for pediatric CP is rare, anxiety is prevalent among families seeking cardiac care.
• Cardiologist reassurance effectively reduces anxiety without extensive testing.
• Increased cardiac testing intensifies family anxiety, leading to more follow-up visits and potential overuse of healthcare resources.