Telehealth Treatment of Anxiety in Patients With Low-Risk Chest Pain in the Emergency Department: The PACER Randomized Clinical Trial.
Paul I Musey, Kurt Kroenke, Jill Nault Connors et al.
✦ AI-curated · Sources linked
In 30 seconds
The PACER multicentre, three-group randomised comparative effectiveness trial tested peer-supported internet-based cognitive behavioural therapy (iCBT) and therapist-delivered telehealth CBT against primary care referral in adults discharged from emergency departments with low-risk chest pain and at least moderate anxiety. Among 375 participants, anxiety improved in all groups over 12 months. Peer-supported iCBT produced 1.22 points greater improvement in GAD-7 scores than primary care referral (95% CI, 0.01-2.43; effect size = 0.25); the difference was greatest among patients with severe anxiety.
Key findings
- GAD-7 scores improved by 4.32, 5.54, and 5.13 points in the primary care referral, peer-supported iCBT, and therapist-delivered CBT groups, respectively.
- Peer-supported iCBT improved GAD-7 scores by 1.22 points more than primary care referral (95% CI, 0.01-2.43; effect size = 0.25).
- The iCBT advantage was strongest among patients with severe anxiety, with a 2.8-point difference.
- Odds of patient-reported global anxiety improvement were 3 times higher in the two CBT groups than with primary care referral; secondary outcomes showed no significant between-group differences.
Why it matters
Anxiety may be undiagnosed or undertreated in patients evaluated for low-risk chest pain. This trial suggests that a remotely delivered, peer-supported CBT option can provide a modest additional reduction in anxiety compared with primary care referral, with a larger reported benefit among those with severe anxiety. It also found improvement within all three groups, underscoring that the between-group advantage was not universal across outcomes.
What to keep in mind
The abstract reports a modest between-group effect for the primary outcome, and secondary outcomes did not differ significantly between groups. The findings apply to adults discharged with low-risk chest pain and elevated anxiety in university health system emergency departments.