A recent study found that virtual cognitive-behavioral therapy (CBT) effectively reduced anxiety among patients experiencing low-risk chest pain who were discharged from emergency departments. This type of chest pain, which is common in the United States with over 8 million cases annually, often leads to significant anxiety even when no serious heart issues are found.
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The PACER trial assessed the effectiveness of three interventions for anxiety management among 375 adults treated at six Indiana University Health emergency departments between April 2021 and July 2024. Participants had moderate to severe anxiety and were expected to leave within 24 hours. Those with high-risk chest pain or other serious conditions were excluded.
The study revealed that around 55% of all patients with low-risk chest pain experience anxiety, leading to repeated visits for care despite negative test results for heart emergencies. Many participants in the trial had other mental health issues, such as 58% experiencing depression and 75% exhibiting panic symptoms.
Among the treatment groups, one received enhanced primary care referrals, another utilized an online CBT program supported by peers, and a third participated in telehealth sessions with a trained therapist. After one year, patients in the peer-supported CBT group showed the most significant decrease in anxiety, with their Generalized Anxiety Disorder-7 scores improving by 1.22 points more than those receiving standard referrals. Therapist-led sessions also showed improvements, although not statistically significant compared to the referral group.
Notably, those who began with severe anxiety benefited even more, demonstrating improvements in anxiety scores by 2.8 points over the primary care group and 2.2 points over the therapist-led group. Overall, improvements were also seen in depression and daily functioning across all groups, with many effects manifesting within the first three months of treatment.
Participation levels correlated with outcomes; patients engaging more consistently with the peer-supported program experienced more significant reductions in anxiety. Throughout the study, researchers noted that only seven major cardiovascular events occurred in the participant group, indicating no substantial safety concerns regarding heart issues during follow-up.
Despite the encouraging results, the study faced limitations, including a high dropout rate, missing follow-up data, and the lack of detailed tracking of medication use. Additionally, since the trial was conducted within a single healthcare system, results may not universally apply. The findings suggest that online CBT, particularly with peer support, could be a promising approach to managing anxiety following low-risk chest pain, warranting further investigation in larger and more diverse populations.