Understanding the Role of Anxiety in Low-Risk Chest Pain Cases in Emergency Departments

Chest pain is a leading reason for patients to visit emergency departments (EDs), ranking as the second most common complaint. While many of these cases are related to heart issues, studies show that approximately 80% are low-risk and not associated with heart disease. These patients often receive diagnoses such as anxiety or panic disorders. Recent research emphasizes that a significant portion of these patients, more than 42%, experience severe anxiety, as measured by standardized tools like the GAD-7 scale, and about 75% screen positive for panic disorder.

A study conducted by researchers from Indiana University School of Medicine and the Regenstrief Institute suggests that many of these low-risk patients could benefit more from treatments targeting psychological conditions rather than extensive cardiac testing. Addressing underlying anxiety and related mental health issues could help in reducing recurrent ED visits and unnecessary diagnostic procedures, leading to better patient outcomes and more efficient healthcare resource use.

Expert insights indicate that anxiety commonly accompanies low-risk chest pain, often co-occurring with depression, somatization, and post-traumatic stress disorder. Dr. Kurt Kroenke explains that many patients worry about their heart health even when the pain isn’t cardiac, raising an important question about appropriate treatment approaches. Implementing therapies for these psychological conditions can significantly improve care.

Effective treatment strategies include cognitive-behavioral therapy (CBT) and medication. CBT helps patients recognize and modify negative thought patterns and manage panic symptoms, leading to improved quality of life. Pharmacological options like antidepressants and anti-anxiety medications are also valuable, especially for chronic anxiety. Combining these approaches offers a comprehensive care plan that can prevent future ED visits.

Dr. Paul Musey highlights the importance of connecting patients with proven therapies beyond reassurance, which often falls short. Early psychological intervention can alter the course of treatment and support long-term relief. Overall, recognizing the psychological component of low-risk chest pain and integrating mental health treatments into emergency care can greatly enhance patient recovery and reduce healthcare burdens.

For more detailed insights, refer to the study: Linh Dang et al, "Psychological Comorbidity in Patients Presenting to the Emergency Department With Low‐Risk Chest Pain and Anxiety," published in Academic Emergency Medicine (2025).