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

Chest pain (CP) in young people is generally benign and rarely cardiac in nature. However, patient and family anxiety regarding pediatric CP is often heightened. In this study, patients and parent/caretakers provided anxiety ratings before and after a pediatric cardiology visit using a protocol for CP assessment. Changes in the anxiety ratings after the visit were measured. Additionally, the correlation between post-visit anxiety, numbers of cardiac tests and likelihood of unplanned return visits for CP were assessed. Patients 7-21 years old evaluated for CP with a standardized protocol from 2010-2014 and their parents/caretakers were asked to rate their anxiety related to CP on a 5-point scale (5 = high anxiety) at the start and end of the visit. Cardiac testing was performed at the provider's discretion and guided by the protocol. CP evaluations occurred in 3,167 patients (mean age 13.3 years) with exertional symptoms in 45%. Echocardiograms were performed in 52% (n = 1,644). A presumed cardiac etiology for CP was present in 7 patients (pericarditis, myocarditis, hypertrophic cardiomyopathy, and coronary anomaly). Mean pre-visit anxiety score was 2.6 (patient) and 3.0 (parent/caretaker) and fell to 1.3 on post-visit assessment for both groups (p < 0.0001). Post-visit patient and parent/caretaker anxiety increased (OR = 1.9 and 1.8, respectively, p-value < 0.0001 both) with increasing number of cardiac tests performed. Likelihood of unplanned return visit (1.4%) increased with higher post-visit parent/caretaker anxiety (OR = 2.88, p < 0.0001). Common reasons for anxiety were concerns for cardiac etiology, cardiac family history, provider concern, and persistent symptoms. Anxiety around pediatric CP is common in families seeking cardiac care. However, a cardiac etiology is rarely identified and reassurance by a cardiologist reduces anxiety without extensive testing. Higher testing rates increase family anxiety, which increases the likelihood of cardiology follow-up and unnecessary resource utilization.