1. Prevalence and Impact of Anxiety Disorders in
Primary care patients presenting with Chest pain:
An Asian perspective
Wang ZS1, Chau MK1, Tan LL1, Nor Diana T1, Tan XY1, Idayu K1, Norizan MY1, Chris ER1, Chia PL1, Sung SC2, Chua SJ2, Tan NC1
1. SingHealth Polyclinics, Singapore
2. Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
3. Department of Cardiology, National Heart Centre, Singapore
Table 1. Baseline Characteristics of the study population
BACKGROUND & AIM
Chest pain1 and anxiety disorders are commonly encountered by the family physician. Anxiety disorder is a risk factor for coronary artery disease2 (CAD). On the other hand, patients with anxiety disorders may present with atypical chest pain3, presenting a diagnostic dilemma.
We aimed to assess the prevalence and impact of anxiety disorders in our Asian primary care cohort presenting with chest pain.
Fig 1.
p = 0.078
Fig 2.
METHOD
Consecutive patients from 9 primary care clinics referred to a tertiary unit for evaluation of chest pain from Jul 2013 to Sep were prospectively recruited. The inclusion criteria was age ≥30years with no known history of CAD.
Anxiety disorders were evaluated by interviewer-administered questionnaires, adapted from the anxiety module of the Patient Health Questionnaire4 (PHQ), and the Generalized Anxiety Disorder 7-item scale5 (GAD-7). GAD was defined as a GAD-7 score of 10 and above. Panic disorder was defined according to the diagnostic algorithm for the PHQ module.
Significant coronary artery disease was defined as ≥50% stenosis on coronary angiography (computed tomography or actual) or a positive functional test with confirmatory clinical correlation by a cardiologist.
CONCLUSION
In our Asian primary care cohort presenting with chest pain, anxiety disorders (GAD and panic disorder) were prevalent at about 20.7%. However, these anxiety disorders did not predict for CAD.
RESULTS
REFERENCES
A total of 507 (249 male, 55.9 ± 11.1 age, 416 Chinese) patients were included in the analysis. The baseline characteristics of the study population are summarized in Table 1. Fifty-seven (11.2%) patients were found to have CAD.
The overall prevalence of anxiety disorders was 20.9% (n=106); 19.1% GAD (n=97) and 3.9% panic disorder (n=20). Amongst patients with GAD, 6.2% had CAD compared to 12.5% in those without GAD (p=0.078). In patients with panic disorder, 5% had CAD compared to 11.5% in those without panic disorder (p=0.367) (Fig1, 2).
On multivariate analysis, both GAD and panic disorders had no significant correlation with CAD in this cohort of patients presenting with chest pain (p>0.05).
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3. Kirk J, Jahoda A. The role of emotional imagery and somatosensory amplification in atypical chest pain in patients with angina pectoris: a single-case experimental design. J Cardiopulm Rehabil Prev 2009;29:121-5
4. Spitzer RL, Kroenke K, Williams JB, for the patient health questionnaire primary care study group. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 1999;282:
5. Spitzer RL, Kroenke K, Williams JB, Loewe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092-7
SPONSOR
This research project was kindly funded by Lee Foundation