Posttraumatic Stress and Myocardial Infarction Risk Perceptions in Hospitalized Acute Coronary Syndrome Patients

Donald Edmondson,Ellen-Ge Denton,Jonathan A Shaffer,Daichi Shimbo,Lynn Clemow

doi:10.3389/fpsyg.2012.00144

Abstract

Posttraumatic stress disorder (PTSD) is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina) recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n = 420). Participants completed a brief PTSD screen 3–7 days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or women their age. Most participants exhibited optimistic bias (mean recurrence risk estimate between “average” and “below average”). Further, participants who screened positive for current PTSD (n = 15) showed significantly greater optimistic bias than those who screened negative (p < 0.05), after adjustment for demographics, ACS severity, medical comorbidities, depression, and self-confidence in their ability to control their heart disease. Clinicians should be aware that psychosocial factors, and PTSD in particular, may be associated with poor adherence to medical advice due to exaggerated optimistic bias in recurrence risk perceptions.

Highlights

Acute coronary syndromes [acute coronary syndrome (ACS); i.e., myocardial infarction (MI), unstable angina (UA)] are highly prevalent (Lloyd-Jones et al, 2010), and survivors are at increased risk for recurrent MI and mortality in the subsequent year (Goldberg et al, 2004; Montalescot et al, 2007)
The following clinical variables were derived from chart review: index ACS type (i.e., MI or UA), Global Registry of Acute Coronary Events (GRACE) risk score (i.e., 6-month post-ACS mortality risk based upon previous MI, heart failure, and in-hospital cardiovascular markers; Goldberg et al, 2004), and Charlson comorbidity score
Participants who screened positive for posttraumatic stress disorder (PTSD) (n = 15, 3.5%) did not differ from those who screened negative on any covariate (Table 1), except that they reported significantly more depressive symptoms (13.3 versus 9.2, p = 0.03)

Summary

Introduction

Acute coronary syndromes [ACS; i.e., myocardial infarction (MI), unstable angina (UA)] are highly prevalent (Lloyd-Jones et al, 2010), and survivors are at increased risk for recurrent MI and mortality in the subsequent year (Goldberg et al, 2004; Montalescot et al, 2007). This increased risk can be managed through adherence to medical advice, post-ACS patients often exhibit poor adherence (Eagle et al, 2005), possibly due to underestimation of their risk for future MI recurrence. Psychological disorders may produce deficits in people’s reasoning abilities

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Results

Conclusion