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Coronary events associated with increased risk for developing PTSD

One in eight patients with acute coronary syndrome experienced clinically significant symptoms of posttraumatic stress disorder, according to recent study results. The same study also showed that posttraumatic stress disorder symptoms in heart patients doubled their risk for death or having another cardiac event.

“Ironically, though the survival benefit conferred by the adoption of new technologies, intervention, and treatment guidelines is a great triumph of modern medicine, it may have also increased the number of patients for whom survival means living with posttraumatic stress disorder (PTSD) due to the [acute coronary syndrome] event,” the researchers wrote.

Donald Edmondson, PhD, Columbia University assistant professor of behavioral medicine, and colleagues conducted a meta-analysis of 24 studies that assessed PTSD with specific reference to an acute coronary syndrome (ACS) event occurring at least 1 month before the PTSD assessment. All studies included self-report PTSD screening instruments or clinical interviews investigating specifically ACS-induced PTSD, and excluded other traumatic events. The researchers used the software program Comprehensive Meta-Analysis, version 2, to determine the prevalence of ACS-induced PTSD and the risk ratio associated with a positive screen for PTSD in 2,383 patients.

 

Donald Edmondson

Results showed that 12% (95% CI, 9-16) of patients developed clinically significant symptoms of ACS-induced PTSD, and 4% (95% CI, 3-5) met full diagnostic criteria for the disorder. The most conservative estimates showed that patients with PTSD symptoms were at double the risk for mortality and ACS recurrence, compared with those without PTSD symptoms (95% CI, 1.69-2.37).

According to the researchers, individual prevalence rates of PTSD symptoms varied significantly between studies as a result of the use of screening instruments (16% in 16 studies; 95% CI, 13-20) vs. clinical diagnostic interviews (4% in eight studies; 95% CI, 3-5).

“While little research exists on treatment of ACS-induced PTSD, a growing body of literature suggests risk factors for PTSD diagnosis and symptom severity after ACS,” the researchers wrote. “These risk factors include intense fear, perceived life threat, lack of control, helplessness and chest pain during ACS, dissociation during the event, acute stress disorder, depression symptoms during hospitalization and history of psychiatric disorder before ACS, alexithymia or neuroticism.”

The researchers added that further research is needed, particularly studies testing treatments for ACS-induced PTSD.

Disclosure: The researchers report no relevant financial disclosures.