Pediatric cardiology
January 5, 2026 · via Europe PMC
Child and Caretaker Anxiety Around Pediatric Chest Pain: A Case for Cardiac Evaluation Using a Standardized Protocol.
Michelson AT, Fulton DR, Toro-Salazar O, Lipsitz S, Saleeb SF.
AI summary — for doctors, generated from the abstract only
In a large pediatric cardiology cohort, cardiac causes of chest pain were rare, and a standardized evaluation protocol with cardiologist reassurance significantly reduced patient and caregiver anxiety, while more extensive cardiac testing was actually associated with increased anxiety and more unplanned return visits.
What was studied
A study of 3,167 pediatric patients aged 7 to 21 years, evaluated for chest pain between 2010 and 2014 using a standardized protocol, measuring patient and caregiver anxiety before and after the cardiology visit, and examining associations between anxiety, number of cardiac tests performed, and likelihood of unplanned return visits.
Key findings
- A cardiac cause of chest pain was identified in only 7 of 3,167 patients, including pericarditis, myocarditis, hypertrophic cardiomyopathy, and coronary anomaly.
- Mean anxiety scores fell significantly after the visit for both patients (2.6 to 1.3) and parents or caregivers (3.0 to 1.3), p<0.0001 for both.
- Increasing number of cardiac tests performed was associated with higher post-visit anxiety in both patients (odds ratio 1.9) and caregivers (odds ratio 1.8), p<0.0001 for both.
- Higher post-visit caregiver anxiety was associated with increased likelihood of unplanned return visits (odds ratio 2.88, p<0.0001); the overall unplanned return visit rate was 1.4%.
Clinical relevance
This suggests that cardiologist reassurance via a standardized evaluation protocol can effectively reduce anxiety around pediatric chest pain without requiring extensive testing, and that more testing may actually increase anxiety and healthcare utilization, supporting judicious, protocol-guided use of testing rather than reflexive extensive workup.
Who should care
Limitations
This study was conducted from 2010 to 2014 at what appears to be a single or limited set of centers, which may not reflect current testing practices; anxiety was measured using a simple 5-point scale rather than validated anxiety instruments.
Cardiac causes of pediatric chest pain are rare, and reassurance from a standardized cardiology evaluation effectively reduces family anxiety, while more extensive testing paradoxically appears to increase anxiety and unnecessary follow-up visits.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Chest pain (CP) in young people is generally benign and rarely cardiac in nature. However, patient and family anxiety regarding pediatric CP is often heightened. In this study, patients and parent/caretakers provided anxiety ratings before and after a pediatric cardiology visit using a protocol for CP assessment. Changes in the anxiety ratings after the visit were measured. Additionally, the correlation between post-visit anxiety, numbers of cardiac tests and likelihood of unplanned return visits for CP were assessed. Patients 7-21 years old evaluated for CP with a standardized protocol from 2010-2014 and their parents/caretakers were asked to rate their anxiety related to CP on a 5-point scale (5 = high anxiety) at the start and end of the visit. Cardiac testing was performed at the provider's discretion and guided by the protocol. CP evaluations occurred in 3,167 patients (mean age 13.3 years) with exertional symptoms in 45%. Echocardiograms were performed in 52% (n = 1,644). A presumed cardiac etiology for CP was present in 7 patients (pericarditis, myocarditis, hypertrophic cardiomyopathy, and coronary anomaly). Mean pre-visit anxiety score was 2.6 (patient) and 3.0 (parent/caretaker) and fell to 1.3 on post-visit assessment for both groups (p < 0.0001). Post-visit patient and parent/caretaker anxiety increased (OR = 1.9 and 1.8, respectively, p-value < 0.0001 both) with increasing number of cardiac tests performed. Likelihood of unplanned return visit (1.4%) increased with higher post-visit parent/caretaker anxiety (OR = 2.88, p < 0.0001). Common reasons for anxiety were concerns for cardiac etiology, cardiac family history, provider concern, and persistent symptoms. Anxiety around pediatric CP is common in families seeking cardiac care. However, a cardiac etiology is rarely identified and reassurance by a cardiologist reduces anxiety without extensive testing. Higher testing rates increase family anxiety, which increases the likelihood of cardiology follow-up and unnecessary resource utilization.
DOI
10.1007/s00246-025-04103-0
PMID
41491075
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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