Telehealth stepped-care intervention for cardiology outpatients with panic-related anxiety: A scoping review

Objective: The objective of this scoping review is to map the current evidence pertaining to telehealth stepped-care intervention for cardiology outpatients with panic-related anxiety. Introduction: Patients with panic-related anxiety frequently present to cardiology departments with symptoms that mimic symptoms of cardiac events, placing a substantial burden on both healthcare systems and patients through repeated visits, unnecessary testing, and delayed appropriate mental health treatment. While stepped-care interventions show promise in treating panic-related anxiety, evidence regarding their feasibility and effectiveness in cardiology settings, particularly via telehealth, remains unknown. Inclusion criteria: This review will include studies examining adults with panic-related anxiety presenting with cardiovascular-like symptoms such as chest pain, heart palpitation, and shortness of breath in any healthcare setting. The primary focus is on telehealth-delivered stepped-care interventions. However, given the limited evidence in this specific area, any telehealth-delivered psychological intervention for panic-related anxiety will be included. Eligible studies will include quantitative research employing experimental, quasi-experimental, or observational designs from any geographic location. Methods: A comprehensive search will be conducted across MEDLINE, PsycINFO, Embase, and Cochrane Library, supplemented by grey literature searches. Two reviewers will independently screen titles, abstracts, and full texts against eligibility criteria. Data will be extracted on study and population characteristics, intervention and telehealth delivery features, comparator details, outcome measures, effectiveness findings, feasibility and acceptability outcomes, and predictors of treatment response, including variables examined and covariates adjusted for. A narrative synthesis approach, supported by tables and figures, will map the evidence and identify patterns, variations, and gaps in the literature.