A Prospective Study of Noncardiac Chest Pain-Related Disability in Emergency Department Patients With Comorbid Anxiety Disorders

Objective: This study aimed to prospectively document the association between panic disorder (PD) or generalized anxiety disorder (GAD) and noncardiac chest pain (NCCP)-related disability. Its second objective was to validate an explanatory model of these associations. Methods: This was a prospective cohort study of 124 emergency department patients with NCCP and comorbid PD or GAD. Anxiety sensitivity, heart -focused anxiety, and alexithymia were assessed at baseline. NCCP-related disability was assessed at baseline and at the 6 -month follow-up. Mediation analysis was used to validate the explanatory model. Results: The rate of NCCP-related disability was 54.8% (n = 68) at baseline and 34.7% (n = 43) at the 6 -month followup. Patients with PD were significantly more likely to report NCCP-related disability at the 6 -month follow-up than those with GAD alone (P = 0.021). A simplified model containing a causal chain between anxiety, anxiety sensitivity, heart -focused anxiety, and NCCP-related disability at the 6 -month followup was a good fit for the data. Conclusions: PD appears to be more closely associated with NCCPrelated disability than GAD. Among patients with NCCP and comorbid PD or GAD, heart -focused anxiety was the main psychological determinant of the development or maintenance of NCCP-related disability in the 6 months following an emergency department visit.