Abstract
Aims:As many as 1 in 8 acute coronary syndrome (ACS) patients develop posttraumatic stress disorder (PTSD) due to the ACS, and ACS-induced PTSD may increase secondary cardiovascular disease (CVD) risk. However, prior studies have been small and underpowered to test plausible behavioral or biological mechanisms of the hypothesized PTSD-secondary CVD risk association. In this paper, we describe the design and methods of a large prospective observational cohort study to estimate the prognostic significance of ACS-induced PTSD, mechanisms for its association with CVD risk, and emergency department (ED) factors that may increase PTSD risk, in a cohort of patients evaluated for acute coronary syndrome (ACS) in the ED of a large, urban academic medical center.Methods:The Reactions to Acute Care and Hospitalization (ReACH) study follows 1,741 racially, ethnically, and socioeconomically diverse patients initially presenting to the ED with ACS symptoms. Psychosocial factors are assessed at baseline. Medication adherence is monitored by electronic pill bottle (eCAP). Participants are contacted by phone at 1-, 6-, and 12-months post-hospitalization to assess PTSD symptoms, hospital readmission, and recurrent CVD events/mortality (proactively searched and confirmed by medical records).Conclusion:This study will provide the most accurate estimates to date of PTSD’s association with recurrent CVD events and mortality and will test whether medication adherence mediates that association. Further, it will provide estimates of the contribution of ED and hospital factors to PTSD risk in ACS patients. If our hypotheses are supported, we will have identified PTSD as a novel target for secondary risk reduction.
Highlights
The Reactions to Acute Care and Hospitalization (ReACH) study tests a theoretical model in which emergency department (ED) factors contribute to the development of posttraumatic stress disorder (PTSD), which may in turn influence prognosis, including risk for cardiac event recurrence and mortality
The study aims are as follows: (1) to test whether suspected acute coronary syndrome (ACS)-induced posttraumatic stress disorder (PTSD) is associated with increased risk of mortality and recurrent major adverse cardiac events (MACE) at 1 year; (2) to determine whether electronicallymeasured medication nonadherence mediates any association of suspected ACS-induced PTSD with cardiovascular disease (CVD) risk; (3) to identify predictors of suspected ACS-induced PTSD that are related to the patient, the physicians, and the ED environment
Other examples of potential mechanisms include autonomic imbalance, low physical activity, and disrupted sleep. This prospective observational study will be the most definitive study to date of PTSD as a psychological reaction to an acute cardiac event, and the short-term psychological outcomes and long-term cardiovascular outcomes associated with PTSD, including subsequent MI and death
Summary
The Impact of Cardiac-induced Post-traumatic Stress Disorder Symptoms on Cardiovascular Outcomes: Design and Rationale of the Prospective Observational Reactions to Acute Care and Hospitalizations (ReACH) Study. Conclusion: This study will provide the most accurate estimates to date of PTSD’s association with recurrent CVD events and mortality and will test whether medication adherence mediates that association It will provide estimates of the contribution of ED and hospital factors to PTSD risk in ACS patients. The ReACH study tests a theoretical model in which ED factors contribute to the development of posttraumatic stress disorder (PTSD), which may in turn influence prognosis, including risk for cardiac event recurrence and mortality. The study aims are as follows: (1) to test whether suspected ACS-induced PTSD is associated with increased risk of mortality and recurrent major adverse cardiac events (MACE) at 1 year; (2) to determine whether electronicallymeasured medication nonadherence mediates any association of suspected ACS-induced PTSD with CVD risk; (3) to identify predictors of suspected ACS-induced PTSD that are related to the patient, the physicians, and the ED environment. By sharing our study design, we hope to present an efficient and efficacious model for conducting prospective observational work in acute care environments such as the ED
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