210EMF Four-Week Text Messaging Follow-Up of Subjects With Low-Risk Chest Pain Associated With Anxiety

Abstract

Approximately 40% of patients presenting to the emergency department (ED) with low-risk chest pain have anxiety as a significant contributor to their symptoms. Often unaddressed in this population, anxiety is associated with multiple psychological comorbidities, impaired quality of life, and significantly higher ED recidivism. Although evidence points to persistent anxiety symptom elevation at six-weeks, traditional methods of follow-up assessment in this population are prone to recall bias given the unpredictable nature of anxiety symptomatology. One method of overcoming this propensity for recall bias is through frequent repeated measures known as ecological momentary assessment (EMA). Short message service (SMS) messaging or text-messaging is a readily accessible and cheap EMA method. Our objective is to determine the feasibility of using an automated weekly SMS text message protocol to assess the prevalence and rate of persistent anxiety symptoms, chest pain recurrence, and ED utilization among a cohort of ED subjects with low-risk chest pain. This is a single academic center, two hospital, prospective observational cohort study of ED subjects with low risk chest pain. Eligible subjects between 18 and 70 years old with no history of acute coronary syndrome (ACS) and a physician-reported HEART score < 4, are eligible for enrollment. The Generalized Anxiety Disorder 7 item scale (GAD-7) is used to stratify participants by anxiety symptom severity: (none ≤4, mild 5-9, moderate 10-14, and severe ≥15). Subjects are followed for a total of 12 weeks receiving automated SMS conversations from our Research Electronic Data Capture (REDCap) software facilitated by third-party partner Twilio. These 9-item SMS conversations assess anxiety symptoms, chest pain recurrence and ED utilization in weeks 1-5 and 7-11. This is an interim analysis using descriptive statistics of this cohort through 4 weeks of follow-up. To date, 117 of the 200 planned subjects have been enrolled and their baseline characteristics are shown in Table 1.The prevalence of abnormal levels of anxiety (moderate or severe) at enrollment was 44% (n=51). GAD-7 scores ≥15 (severe) were found in 30 subjects (26%). The overall study response rate to SMS prompts is 76%. Two and four-week follow-up SMS response rates are 74% and 72% respectively. At 2 weeks, of the 41 responding subjects with abnormal anxiety at enrollment, 26 (64%) had persistently abnormal scores. Additionally, of the subjects with severe anxiety at enrollment, 77% remained abnormal compared with 40% of those with moderate scores at 2 weeks. For subjects with severe anxiety at enrollment, the rate of persistently abnormal anxiety was 72% at 4 weeks. In this interim analysis investigating the feasibility of using automated SMS conversations for follow-up of low risk chest patients, our rate of SMS response is >75%, which is currently higher than our a priori feasibility threshold of 70%. Additionally, >70% of those with severe anxiety symptoms at enrollment had persistently abnormal anxiety scores at 2- and 4-week SMS follow-up.Tabled 1Baseline cohort demographicsGAD-7 ≤9 (n=66)GAD-7 ≥10 (n=51)Age43.743.8Female Sex39 (59%)33 (65%)Race/EthnicityBlack28 (42%)37 (73%)White34 (52%)12 (24%)Hispanic3 (5%)4 (8%) Open table in a new tab