Project Summary
This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.
What is the research about?
Chest pain is the second most common reason why people go to the emergency room, or ER. Many people who go to the ER for chest pain are at low risk for a heart attack. In about half of these low-risk patients, chest pain is due to anxiety. But when ER doctors rule out heart attack and patients go home, the patients’ anxiety often goes untreated. Diagnosing and treating anxiety is important to prevent symptoms of anxiety and future ER visits.
One way to treat anxiety is with cognitive behavioral therapy, or CBT. In CBT, patients learn to change patterns in their thinking to improve how they feel.
In this study, the research team is comparing three ways to treat anxiety in patients who have gone to the ER with chest pain:
- Referral to a primary care doctor
- Online self-help CBT with peer support
- Therapist-led CBT
Who can this research help?
Results may help patients and doctors when considering ways to treat anxiety in patients who go to the ER with low-risk chest pain.
What is the research team doing?
The research team is screening patients who go to the ER with low-risk chest pain for anxiety. The team is enrolling 375 adult patients with high levels of anxiety in the study. Then the team is assigning patients by chance to one of three groups.
Patients in the first group receive a referral to a primary care doctor for anxiety. The research team is sharing the results of the anxiety screening with these doctors. Patients in this group also receive an educational brochure on anxiety and its treatment.
Patients in the second group receive an online CBT course. The course includes six lessons over 8–12 weeks on topics such as managing worry and facing fears. Patients in this group also receive peer support from certified peer recovery specialists. Patients who experience panic complete two more lessons that teach them ways to address panic based on exposure therapy. This treatment involves exposing patients to the source of their anxiety, without any danger, to help them overcome their distress.
Patients in the third group receive eight one-hour CBT sessions with a therapist. Sessions take place by computer or by phone over 12 weeks. Patients who experience panic also receive exposure therapy.
The research team is asking patients about their anxiety symptoms 3, 6, 9, and 12 months after the start of the study. The team is also looking at patients’:
- Symptoms of panic
- Chest pain
- Physical symptoms
- Depression symptoms
- Work, family, and social functioning
- ER visits
Patients with low-risk chest pain and high anxiety, emergency medicine doctors, and psychologists are helping to plan and conduct this study.
Research methods at a glance
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 375 adults ages 18 and older with anxiety who present in the ER with low-risk chest pain |
| Interventions/ Comparators |
|
| Outcomes |
Primary: anxiety symptoms Secondary: panic symptoms; chest pain; physical symptoms; depression symptoms; ability to function at work, with family, and socially; patient-rated anxiety; ER visits; major adverse cardiac events |
| Timeframe | 3-month follow-up for primary outcome |