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Anxiety about anxiety: a survey of emergency department provider beliefs and practices regarding anxiety-associated low risk chest pain

机译：焦虑症焦虑症：急诊服务提供者对与焦虑症相关的低风险胸痛的信念和做法的调查

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Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism. To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique. The survey was administered to a convenience sample of ED providers attending the 2016 American College of Emergency Physicians Scientific Assembly in Las Vegas. Surveys were completed by 409 emergency medicine providers from 46 states and 7 countries with a wide range of years of experience and primary practice environment (academic versus community centers). Respondents estimated that 30% of patients presenting to the ED with chest pain thought to be low risk for ACS have anxiety or panic as the primary cause but they directly communicate this belief to only 42% of these patients and provide discharge instructions to 48%. Only 39% of respondents reported adequate hospital resources to ensure follow-up. Community-based providers reported more adequate follow-up for these patients than their academic center colleagues (46% vs. 34%; p?=?0.015). Most providers (82%) indicated that they wanted to have referral resources available to a specific clinic for further outpatient evaluation. Emergency Department providers believe approximately 30% of patients seeking emergency care for chest pain at low risk for ACS have anxiety as a primary problem, yet fewer than half discuss this concern or provide information to help the patient manage anxiety. This highlights an opportunity for patient centered communication.
机译：出现在急诊科（ED）的胸痛患者中，大约80％没有真正的心肺急症，例如急性冠脉综合征（ACS）。但是，据认为，焦虑症等心理因素的发生率高达58％，但常常未被诊断，导致慢性胸痛和ED累犯。为了评估急诊服务提供者的信念及其对与焦虑相关的低风险胸痛患者的处置方式和处置的惯常做法，我们使用改良的Delphi技术构建了一项22个项目的调查。该调查是针对参加拉斯维加斯2016年美国急诊医师科学大会的ED提供者的便利样本进行的。来自46个州和7个国家的409名急诊医疗服务提供者完成了调查，这些医疗人员具有多年的经验和主要执业环境（学术中心与社区中心）。受访者估计，在急诊部就诊的胸痛被认为是ACS风险低的急诊科患者中，焦虑或惊恐是其主要病因，但他们仅将此类信念直接传达给了这些患者中的42％，并向48％的患者提供了出院指导。只有39％的受访者表示有足够的​​医院资源来确保随访。以社区为基础的提供者报告说，对这些患者的随访要比其学术中心的同事要多（46％比34％; p = 0.015）。大多数提供者（82％）表示他们希望将推荐资源提供给特定诊所，以进行进一步的门诊评估。急诊科的提供者认为，大约有30％的需要进行ACS低危的胸痛急诊的患者将焦虑症作为主要问题，但只有不到一半的人讨论此问题或提供信息来帮助患者管理焦虑症。这突出了以患者为中心的交流机会。

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