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Objective: The aim of this study was to determine the prevalence of anxiety and depressive disorders in patients presenting with chest pain to the Emergency Department (ED) and determine if there is a relationship between these and cardiac vs. non-cardiac chest pain.
Methods: This prospective cross-sectional study was performed in an urban tertiary care hospital between March and October 2005. Consecutive patients presenting with chest pain were enrolled in the study. The prevalence of anxiety and depressive disorders in patients with chest pain were determined by using the Hospital Anxiety and Depression Scale.
Results: A total of 324 patients presented to the ED with chest pain during the study period. The mean age of the patients studied was 50.5 ± 14 years; 67% were men and 33% were women. Of the 324 study patients, 194 (59.9%) patients were diagnosed with non-cardiac chest pain, 16 (4.9%) with stable angina, 84 (25.9%) with unstable angina, and 30 (9.3%) with acute myocardial infarction. No statistically significant differences were determined between patients with cardiac and non-cardiac chest pain both for anxiety (40% vs. 38.1%, respectively; p = 0.737) and depressive disorders (52.3% vs. 52.1%, respectively; p = 0.965).
Conclusion: Anxiety and depressive disorders are common among patients presenting with chest pain to the ED. However, the prevalence of anxiety and depressive disorders is similar between patients with chest pain of cardiac and non-cardiac origin. Chest pain should not be attributed to an anxiety or depressive disorder before organic etiologies are excluded.
Methods: This prospective cross-sectional study was performed in an urban tertiary care hospital between March and October 2005. Consecutive patients presenting with chest pain were enrolled in the study. The prevalence of anxiety and depressive disorders in patients with chest pain were determined by using the Hospital Anxiety and Depression Scale.
Results: A total of 324 patients presented to the ED with chest pain during the study period. The mean age of the patients studied was 50.5 ± 14 years; 67% were men and 33% were women. Of the 324 study patients, 194 (59.9%) patients were diagnosed with non-cardiac chest pain, 16 (4.9%) with stable angina, 84 (25.9%) with unstable angina, and 30 (9.3%) with acute myocardial infarction. No statistically significant differences were determined between patients with cardiac and non-cardiac chest pain both for anxiety (40% vs. 38.1%, respectively; p = 0.737) and depressive disorders (52.3% vs. 52.1%, respectively; p = 0.965).
Conclusion: Anxiety and depressive disorders are common among patients presenting with chest pain to the ED. However, the prevalence of anxiety and depressive disorders is similar between patients with chest pain of cardiac and non-cardiac origin. Chest pain should not be attributed to an anxiety or depressive disorder before organic etiologies are excluded.
Introduction
Chest pain is one of the most common complaints among patients presenting to the Emergency Department (ED). Of these patients, approximately one-third are diagnosed with acute coronary syndromes (ACS), and the remaining two-thirds with non-cardiac chest pain. The patients with non-cardiac chest pain often undergo unnecessary diagnostic procedures and hospitalization, which contributes to increased health care expenditure.Studies have shown that non-cardiac chest pain in the emergency setting may be associated with psychiatric disorders, especially panic, anxiety, and depressive disorders. Studies cite the prevalence of panic disorders among patients with non-specific chest pain ranging from 16% to 43%. Similarly, anxiety and depressive disorders among non-specific chest pain patients range from 23% to 57%. Non-specific chest pain associated with panic and depressive disorders contributes to increased utilization of the ED, and anxiety similarly increases health care consumption among patients with a history of myocardial infarction. Earlier studies focused on the relationship between psychiatric disorders and non-specific chest pain. More recent studies report a high prevalence of panic, anxiety, and depressive disorders among patients with and without coronary artery disease. Additionally, anxiety and depression are common in acute coronary syndromes. Depression and anxiety are also related to poor prognosis in coronary artery disease and recurrent cardiac events, even after adjusting other risk factors for mortality. Depression is related to lower mental health, which subsequently impairs quality of life. Additionally, it is also related to symptoms impairing quality of life, like chest pain during anger, palpitation without physical exercise, trembling of hands and voice, and jerking of muscles.
Emergency Physicians may commonly attribute non-specific chest pain to anxiety disorders or somatization. Although the relationship between somatization and anxiety and depression should not be disregarded, organic etiologies should primarily be excluded. Furthermore, chest pain may cause anxiety and depression. Anxiety causes chest pain in 15% of patients secondary to hyperventilation. This study seeks to determine whether there exists a difference between patients presenting with cardiac and non-cardiac chest pain, and to establish the prevalence of anxiety and depression disorders in patients presenting with chest pain to the ED.
