Use of the Hospital Anxiety and Depression Scale (HADS) in a Cardiac Emergency Room – Chest Pain Unit

Abstract

OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered "probable case" of anxiety or depression. RESULTS: According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. CONCLUSION: The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life

The prevalence and correlates of psychological outcomes in patients with acute non-cardiac chest pain: a systematic review

“…NCCP patients were found to have similar anxiety scores to CCP patients,26–28 but higher levels of anxiety than patients with a determined cause (be it cardiac or another disease such as pneumonia)30 and healthy controls 20 30. Likewise, the percentage of respondents scoring above predefined cut-off scores for probable anxiety was similar for NCCP and CCP patients,26 27 but higher among NCCP patients than those with a determined cause for their chest pain30 and healthy controls 20. The mean baseline anxiety scores for NCCP patients tended to be just below the cut-off for mild anxiety; nonetheless, between 21% and 53.5% of NCCP patients were categorised as probably having anxiety, although it should be noted that different cut-off scores were used across studies.…”

“…There was some variety in the procedures for excluding cardiac causes of chest pain. Most studies reported procedures similar to CPU care (ie, blood tests for cardiac enzymes, ECG, chest x-ray, exercise tolerance test) or equally thorough processes,22–27 30 whereas one study only reported using physical examination and ECG to rule out cardiac causes 29. Two studies did not provide sufficient information on the testing procedures 20 28.…”

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

“…More than half of the patients consulting the emergency department due to chest pain are diagnosed with non-cardiac chest pain (NCCP) or unexplained chest pain. 2,[7][8][9][10][11][12] Non-cardiac chest pain is defined as angina-like pain with no evidence of ischemic heart disease (IHD) 2,8 and unexplained chest pain as pain that has not been explained by any obvious organic cause. 13 While there are well established guidelines for diagnosing and treating patients with IHD, [14][15][16] an international consensus approach to treat patients with NCCP is lacking.…”

Depressive morbidity among elderly individuals who are hospitalized, reside at long-term care facilities, and are under outpatient care in Brazil: a meta-analysis

“…Of these studies, that by Almeida (1999) was excluded because it assessed patients with dementia, seven studies were excluded because they assessed community-based elderly individuals, [10][11][12][13][14][15][16] and five were excluded because they did not report prevalence rates among the elderly. [17][18][19][20][21] Six studies that assessed samples comprising less than 100 individuals [22][23][24][25][26][27] were retained. In the study conducted by Porcu et al, 24 elderly subjects were investigated in hospitals and LTCFs and the respective prevalence rates reported separately.…”