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Musey's team surveyed patients regarding their symptoms, finding that anxiety contributed to chest pain experienced by 30 to 40 percent of low-risk patients seen in hospital emergency departments.

Heart attack or panic attack?

Dr. Paul Musey uses REDCap, IU's web app for online surveys and databases, to study chest pain associated with anxiety

Every year, millions of Americans visit the hospital emergency department with symptoms like intense chest pain, shortness of breath, dizziness, nausea, and extreme fatigue. Given that these symptoms are most readily associated with a heart attack, a trip to the ED is an understandable, and smart, choice.

But these same symptoms can also indicate an anxiety-induced panic attack. Dr. Paul Musey, assistant professor of emergency medicine at the Indiana University School of Medicine, wants to minimize these unnecessary ED visits and link patients with appropriate resources and care.

The team's research seeks to establish best practices for identifying patients with low-risk chest pain associated with anxiety, characteristics of this patient population, and treatment to suit their needs.

Musey and his team are researching how to quantify the importance of “psychosomatic contributors such as panic or anxiety disorders to the chest pain symptom complex,” Musey said. Their research seeks to establish best practices for identifying patients with low-risk chest pain associated with anxiety, characteristics of this patient population, and treatment to suit their needs.

Musey explores the relationship between anxiety and chest pain from the perspective of both patient and doctor. To gather essential data, Musey enlisted REDCap, a secure, web-based platform to support data collection and management. The team surveyed patients regarding their symptoms, finding that anxiety contributed to chest pain experienced by 30 to 40 percent of low-risk patients seen in hospital emergency departments.

In a recent article in The American Journal of Cardiology, Dr. Musey observed that 47 percent of a cohort of low-risk chest pain subjects exhibited abnormal anxiety symptoms, which correlated to a high rate of ED recidivism and a low rate of medical diagnoses.

However, he also noted that many of these subjects reliably self-reported anxiety as a possible cause of their chest pain. The subjects, according to Musey, exhibit self-awareness that can yield valuable information for patient and doctor alike in the diagnostic process.

The team also surveyed doctors to determine how often they suspected anxiety as a cause for chest pain, and their course of action based on that assessment. To assess ED provider beliefs, the team administered a 22-item survey at the 2016 American College of Emergency Physicians Assembly. Ultimately, this study found that ED providers believe that, of patients with low risk for acute coronary syndrome (ACS), roughly 30 percent have anxiety as a primary problem. However, fewer than half of providers voice this concern to the patient or provide information to help the patient manage anxiety.

Currently Musey is leveraging REDCap’s partnership with Twilio to determine the feasibility and acceptance of using automated weekly SMS text messages to assess anxiety symptoms, chest pain recurrence, and ED utilization among a cohort of ED subjects with low-risk chest pain. In this way, Musey’s research has highlighted an important opportunity to implement patient-centered communication.

For patients experiencing anxiety that may, as Musey notes, “drive them toward low-value healthcare utilization,” a provider’s intervention can offer a touchpoint for accessing the care they need while steering them clear of costly ED visits. Musey’s research indicates the potential utility of early identification of a tendency toward anxiety using a screening process, coupled with appropriate referrals, in breaking this cycle.