Evaluation of a Musical Intervention on the Anxiety of Patients With a Diagnosis of Acute Coronary Syndrome in a Pre-Hospital Emergency Situation: MuSCA Randomized Controlled Trial - Trial NCT06017947

Timeline & Enrollment

Primary Outcome

Anxiety change

Summary

Acute coronary syndrome (ACS) encompasses a continuum of clinical situations secondary to
 acute myocardial ischemia. In France, it is a major health problem and represented 60,000 to
 65,000 hospitalizations in 2010. In 2015, a diagnosis of ACS was made in 15 to 25% of
 patients consulting for chest pain in emergency medicine.
 
 The incidence of ACS is estimated between 80,000 and 100,000 new cases per year. At the
 University Hospital Center (CHU) of Réunion, acute chest pain is the leading cause of
 discharges from the Mobile Emergency and Resuscitation Service (SMUR). In 2019, it
 represented 23% of exits, 8.5% of which concerned SCAs.
 
 The SCA can be anxiety-provoking due to its unexpected and brutal nature. Pain related to
 myocardial ischemia generates anxiety. This increases when patients associate these pains
 with death. This anxiety is exacerbated by waiting times for care, especially for patients
 living in rural areas. In addition, conditions relating to medical care such as noise and the
 pre-hospital medical environment are perceived as influencing anxiety by patients.
 
 The prevalence of anxiety is high, ranging from 30 to 48.5%, in patients with chest pain
 and/or ACS. A 2020 meta-analysis revealed that anxious patients at the start of their ACS
 treatment had an increased risk of death, non-fatal myocardial infarction, rehospitalization,
 recurrence of ACS and the need for coronary revascularization repeated. Overall, ACS patients
 with anxiety have a 21% increased risk of mortality and 47% increased risk of adverse
 cardiovascular events compared to those without anxiety.
 
 Pre-hospital anxiolytic treatment is therefore essential and consists above all in reassuring
 the patient with ACS. Medicated anxiolytics are often combined with analgesics and
 recommended in front of a picture of agitation due to anxiety. However, negative effects may
 interfere, making clinical monitoring of these patients unsuitable. At the same time, several
 studies note that anxiety is underdiagnosed and undertreated in the care of these patients.
 
 In reducing the anxiety of patients with ACS, unconventional care techniques such as
 aromatherapy or touch massage have demonstrated their effectiveness. Music therapy is
 recognized in reducing the anxiety of patients in intensive care or Cardiology.
 
 To the knowledge, in France, the effect of a musical intervention on patients with
 pre-hospital ACS has not yet been studied. It is in this context that the MuSCA study takes
 place.

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