Abstract P248: Posttraumatic Stress Disorder Intrusions Are Associated with Prehospital Delay in Patients with Myocardial Infarction

Abstract

INTRODUCTION: Increased pre-hospital delay prior to presentation for myocardial infarction (MI) is associated with poor outcomes. A history of post-traumatic stress disorder (PTSD), particularly intrusive reexperiencing of trauma, may also be associated with poor outcomes after MI. It is unknown, however, whether PTSD intrusions are associated with pre-hospital delay. METHODS: Patients (n=151) presenting to the emergency room with an MI in the Prescription Use, Lifestyle, Stress Evaluation (PULSE) study were included in this study. Patients reporting a traumatic event with intrusive reexperiencing prior to their MI, as recorded on a questionnaire administered by study staff, were considered to have PTSD intrusions. Pre-hospital delay was defined as the difference between patient-reported symptom onset and presentation time as documented in the medical record. RESULTS: Patients who had PTSD intrusions ( N = 26, 17%) versus those without intrusions ( N = 125; 83%) were younger (mean age: 58 vs. 63 years), more likely to be depressed (68% vs. 37%), and had a higher LVEF (53% vs. 46%). Pre-hospital delay was longer for participants with, compared to without, PTSD intrusions [geometric mean: 11.6 hours (95% CI 6.2-21.6) vs. 6.2 hours (95% CI 4.9-8.1)] P =0.05. After multivariable adjustment for age, sex, ethnicity, depression, LVEF, MI type (ST-elevation vs. non-ST-elevation) and history of prior MI, the mean pre-hospital delay was 136% (95% CI: 17% - 372%) longer for patients with versus without PTSD intrusions (Table). CONCLUSION: Among patients presenting with an MI, PTSD intrusions were associated with longer pre-hospital delays. Future studies should examine the behavioral mechanisms underlying longer pre-hospital delay for patients with PTSD intrusions. Model Covariate adjustment Percent delay (95% CI) intrusions vs. no intrusions p-value 1: Unadjusted 85% longer (0% - 244%) 0.05 2: Age, sex, ethnicity 97% longer (6% - 270%) 0.03 3: Model 2 and depression MI type, LVEF, prior MI 136% longer (17% - 372%) 0.02