Regenstrief University School of Medicine and Regenstrief Institute research scientists have received a $ 3.4 million award from the Patient-Based Outcomes Research Institute (PCORI) to study the best care options for the 40 percent of people who go to the emergency department the hospital with chest pain that has been proven to be caused by anxiety rather than a heart event.
Emergency department care for anxiety usually ends with discharge once a heart attack or related problem has been ruled out. Many of these patients leave the hospital confused about the cause of their chest pain symptoms and what should be done next. As a result, they often suffer and may return due to persistent or recurrent symptoms.
Chest pain and heartless anxiety can be a vicious circle. Patients with low-risk chest pain due to anxiety are sent home because the emergency department is designed for emergencies and anxiety is not an emergency. Barriers in dealing with anxiety in the emergency situation include limited time, competing priorities, discomfort with mental health issues and perceived lack of resources. But even if roadblocks are removed, providers still do not know which anxiety treatment options are most effective. “
Kurt Kroenke, MD, Research Scientist of the Regenstrief Institute and Professor of Medicine Chancellor of the IU School of Medicine
Kurt Kroenke, MD, is the lead dual reviewer on the PCORI contract
Chest pain sends millions of Americans to the hospital every year for fear of getting a heart attack. But historically, 8 out of 10 patients evaluated in hospital emergency departments did not have chest pain caused by a heart attack or other heart event. Confusion – undiagnosed, untreated or untreated cause is the most likely cause of physical symptoms in as many as half of breast pain patients who are considered at low risk for a heart event.
With input from patients with live experiences, clinicians, researchers and health system leaders, Drs. Kroenke, a pioneer in symptom analysis and co-developer of the most common primary care anxiety screening tool, and lead investigator Paul Musey, MD, IU School of Medicine assistant professor in emergency medicine, is examining what which emergency departments can take to support the large number of individuals whose breast pain results from anxiety. Other principal investigators are Jill Connors, PhD, from the Department of Surgery of the IU School of Medicine and Patrick Monahan, PhD, from the Department of Biostatistics. Dr. Monahan is an affiliated scientist with the Regenstrief Institute.
“This type of study is well timed and well placed with online and telehealth care delivery options as there is a growing awareness of the need to provide patients with meaningful care through this global pandemic. , “said Dr. Musey.
A total of 375 adults with chest pain diagnosed when examined in the emergency department will be the result of anxiety, randomly divided into three groups for the study. One group (intensive care support) will be sent to a primary care center for the treatment of anxiety. The second group (moderate intensive support) will be brought to web-based automated mental behavior (CBT) therapy reinforced by peer support from people who understand the challenges of managing anxiety . The third group (high intensity support) will be brought to CBT live video chat sessions with a psychologist.
Emergency department care is stressful and expensive. Finding anxiety in low-risk breast pain patients and treatment referral options would be of great value for both patients and health care systems.
To determine the best care option, success will be measured by reductions in:
- clinical signs of anxiety;
- chest pain and associated physical symptoms;
- deficiencies in work, family and social work; and
- visit back to the emergency department.
The ultimate goal of the research team for the three-year project is to produce evidence that will help patients deal with both anxiety and pain as well as assist clinicians to make appropriate decisions. on how to handle anxiety in patients with chest pain who come to a department hospital emergency.