Mindfulness-Based Stress Reduction for Adults With Low-Risk Chest Pain Associated With Anxiety

Mindfulness-Based Stress Reduction for Adults With Low-Risk Chest Pain Associated With Anxiety: A Pilot Randomized Trial

This Emergency Department based study investigates the feasibility and effectiveness of a mindfulness based stress reduction (MBSR) training program referral for patients with chest pain at low risk for acute coronary syndrome but associated with anxiety. Outcomes assessed for eligible patients randomized to MBSR vs. usual care include mental health (longitudinal Generalized Anxiety Disorder - 7 (GAD-7) scores), quality of life (PROMIS Global Short Form), and ED resource utilization (return Emergency Department (ED) visits).

To determine the effect of an MBSR training program for patients with low-risk chest pain associated with anxiety on mental health (longitudinal GAD-7 scores, quality of life (PROMIS Global Short Form), and ED resource utilization (return ED visits). The working hypothesis is that early referral to MBSR will help patients better regulate their thoughts, feelings, and bodily sensations related to their anxiety symptoms and have a significant positive effect on patient-centered outcomes such as mental health, quality of life as well as decreased ED resource utilization. To this end the investigators will randomize patients identified via a two step process (HEART Score <4 and GAD-7 score > 9 to usual care referrals versus MBSR. The investigators will then follow these participants for outcomes including change in GAD-7 scores, PROMIS Global Short Form, ED utilization among other outcomes at 6 weeks, 3 months, 6 months, and 1 year.

Subjects will be referred for primary care provider (PCP) follow up and/or to psychiatry for further management and treatment of elevated anxiety levels according to standard of care.

Referral for mindfulness-based stress reduction (MBSR), a structured meditation training program consisting of 8 weekly group sessions.

12-item measure (each scored 1-4) with total of 48. A higher score is consistent with greater mindfulness qualities.

13-item state-mindfulness measure that has two sub-scales: Curiosity, 6 items, subscale score ranging from 0-24, and Decentering, 7 items, with a subscale score ranging from 0-28.

Measure of current depression: None - Minimal depression (0 to 4), Mild depression (5 to 9), Moderate depression (10 to 14), Moderately severe depression (15 to 19), Severe depression (20 to 24)

5 item measure (each scored 0 or 1). Higher score associated with higher likelihood of a panic disorder.

3 item measure (each scored 1-4) with total possible score of 12. Higher score associated with higher social anxiety

Inclusion Criteria: Chief complaint of chest pain HEART Score of 0-3 indicating Major Adverse Cardiac Events (MACE) risk equivalent to ≤2% GAD-7 score > or = 10 Exclusion Criteria: Age <18 or ≥ 71 Chief complaint of anxiety, panic, or similar Prior personal acute coronary syndrome (ACS) history (known at time of provider interview) Previous enrollment in the study Traumatic injury to the chest Suicidal ideation or active psychosis or behavioral issues requiring psychiatric monitoring Hemodynamic instability Non-English speaking Potential issues affecting follow up: Prisoners, homeless patients, out-of-town residences