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Predicting Panic Disorder Among Patients With Chest Pain: An Analysis of the Literature

Received May 14, 2002; revision received Sept. 18, 2002; accepted Oct. 4, 2002. From the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School; and McLean Hospital, Belmont, Mass. Address correspondence and reprint requests to Dr. Huffman, Massachusetts General Hospital, Warren 605, Boston, MA 02114; JHuffman{at}partners.org (e-mail).

As many as 25% of patients with chest pain who come to hospital emergency departments have panic disorder. Rates of panic disorder are even higher among those who present for outpatient evaluation of their chest pain. Unfortunately, panic disorder remains largely undiagnosed and untreated in these settings. The authors reviewed studies published between 1970 and 2001 that addressed the prevalence of panic disorder among persons who seek treatment for chest pain in an emergency department or outpatient cardiology clinic. A meta-analysis of the findings revealed five variables that appear to correlate with higher rates of panic disorder among persons who present with chest pain: 1) absence of coronary artery disease, 2) atypical quality of chest pain, 3) female sex, 4) younger age, and 5) a high level of self-reported anxiety. Further studies of these and other variables associated with panic disorder should aid in the detection of this disabling but treatable cause of chest pain.

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