Panic attacks and emergency-care use

A panic attack produces intense autonomic symptoms: chest tightness, palpitations, shortness of breath, a feeling of impending doom. The physical experience is indistinguishable from a cardiac event without a workup. A person having a first attack, especially at rest or overnight, will reasonably go to the ED. Chest pain is the second-most-common reason for adult ED visits after abdominal pain in NHAMCS. The evaluation is medically necessary; the ED is doing the right thing to work it up.

Fleet and colleagues' 1996 study of an ambulatory cardiology clinic sample found panic disorder in roughly a quarter of patients with non-cardiac chest pain. Katerndahl's subsequent work in family medicine and ED settings found similar rates. Not every patient with non-cardiac chest pain has panic, and not every patient with panic will meet criteria for panic disorder, but the fraction is large enough that panic should be on the differential once cardiac and other medical causes are ruled out.

Cost and utilization studies consistently find that untreated panic disorder is associated with high healthcare utilization: repeat ED visits, extensive workups, and multiple medical specialty consultations. Effective outpatient treatment, specifically CBT with interoceptive exposure or an SSRI, reduces this utilization pattern in cohort studies. The ED-to-outpatient linkage is the point where the pathway commonly breaks: many patients leave the ED without a psychiatric diagnosis, referral, or follow-up plan.

Association between panic and repeat ED use is not proof that missed diagnosis is the sole driver. Some patients have both cardiac disease and panic. Some panic-like symptoms are due to thyroid disease, stimulants, alcohol withdrawal, or arrhythmias, and reasonable workup is required. The ED is not the setting where panic disorder is best treated; the point of good ED care is stabilizing the patient, ruling out medical causes, and connecting them to outpatient care.

Panic and acute anxiety are a recognized driver of emergency department visits. A panic attack produces intense physical symptoms, including chest pain, a pounding heart, shortness of breath, and a feeling of dread, and those symptoms closely resemble a cardiac emergency. Many people experiencing a first panic attack reasonably go to an emergency department, and chest pain is one of the most common reasons for emergency visits overall, with roughly 6 to 7 million adult ED visits per year for chest pain per CDC's National Hospital Ambulatory Medical Care Survey.

Research on emergency care for panic, including Fleet and colleagues' influential 1996 American Journal of Medicine study and Katerndahl's follow-up work, shows two consistent patterns. First, a meaningful share of patients who present with chest pain and no cardiac cause are experiencing panic or anxiety, and panic disorder is under-recognized in that setting. Fleet's cardiology-clinic sample found panic disorder in roughly a quarter of patients with non-cardiac chest pain. Second, an emergency visit often doesn't connect the patient to ongoing outpatient care, so repeat visits are common when the underlying anxiety isn't addressed.

The clinical point cuts both ways. New cardiac-type symptoms should be medically evaluated and not assumed to be anxiety, especially a first episode. Once a cardiac and other medical workup is clear, recognizing panic and linking the patient to treatment can prevent a cycle of repeat emergency visits.

National emergency-visit data changes with each release of the underlying survey. Any specific volume figure should be cited from the most recent year available rather than carried forward.

Panic disorder is a specific DSM-5-TR diagnosis; not every panic attack means a panic disorder. Isolated panic attacks are common; the disorder requires recurrent attacks plus persistent worry or behavior change.