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
  • Primary care with enhanced care coordination
  • Online self-administered CBT plus peer support
  • Therapist-administered CBT

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

Project Information

Paul Musey, MD
Kurt Kroenke, MD
Trustees of Indiana University
Addressing Anxiety among Low-Risk Chest Pain Patients in the Emergency Department

Key Dates

June 2020
December 2024


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 14, 2024