Prevalence and recognition of panic states in STARNET patients presenting with chest pain

The purpose of this study was to document the prevalence of panic states in patients presenting with chest pain in primary care settings, to determine the recognition rate of panic states by family physicians, and to assess the impact of lack of recognition on interventions and costs.

Patients from the South Texas Ambulatory Research Network (STARNET) presenting with a new complaint of chest pain were asked to participate in the study. Before seeing their physician, subjects completed the panic disorder section of the Structured Clinical Interview (SCID) of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. The SCID was used to assign diagnoses of panic disorder, infrequent panic, or limited symptom attacks. Health care outcomes included medications prescribed, tests ordered, follow-up and referrals, costs, and physician diagnosis.

Although approximately one half of the 51 patients in this study met criteria for either panic disorder or infrequent panic, few were recognized by physicians as having a panic state (kappa = -.003). Patients with panic disorder were more likely to receive follow-up or referral (P = .042), incurring higher follow-up costs (P = .080). Patients with infrequent panic received more testing (P = .008), with higher costs for testing (P = .001) and higher overall costs (P = .067). Panic-diagnosis associations were found between psychotropic (P = .001) and total (P = .070) medications as well as follow-up and referral costs (P = .009).

Although common, panic states are rarely recognized in patients presenting with complaints of chest pain. The presence of panic leads to more testing, follow-up, and referral with subsequent higher costs. Failure to diagnose panic results in increased prescribing of medications, higher costs, and inappropriate pharmacotherapy.