Association between cardiac event-induced PTSD symptoms and daily intrusive thoughts about cardiac risk: An ecological momentary assessment study

Abstract

Objective: Posttraumatic stress symptoms (PSS) due to acute cardiac events are common and may lead patients to avoid secondary prevention behaviors. However, patients' daily experience of cardiac event-induced PSS has not been studied after a potentially traumatic cardiac hospitalization.

Method: In an observational cohort study, 108 mostly male patients with coronary heart disease were recruited after evaluation for suspected acute coronary syndrome (ACS). One month later, PSS were assessed via telephone-administered PTSD Checklist for DSM-5 (PCL-5). The exposure of interest was elevated (PCL-5 ≥ 20) vs. non-elevated PSS (PCL-5 ≤ 5). The occurrence and severity of cardiac-related intrusive thoughts were assessed 5 times daily for 2 weeks via electronic surveys on a wrist-worn device.

Results: Moderate-to-severe intrusive thoughts were experienced by 48.1% of patients but more commonly by elevated-PSS (n = 36; 66.7%) than non-elevated-PSS (n = 72; 38.9%) patients. After adjustment for demographic and clinical characteristics, elevated- vs. non-elevated-PSS patients had a 9-fold higher odds of experiencing a moderate-to-severe intrusive thought during each 2-h assessment interval (adjusted OR = 9.14, 95% CI [2.99, 27.92], p < .01). After adjustment, intrusive thoughts on a 0-to-6 point scale were over two times as intense for elevated-PSS vs. non-elevated-PSS patients.

Conclusions: Intrusive thoughts about cardiac risk were common in patients recently evaluated for ACS, but much more prevalent and intense in those with elevated vs non-elevated PSS.

Keywords: Acute coronary syndrome; Cardiovascular disease; Intrusive thoughts; Posttraumatic stress.

Figure 1

Posttraumatic Stress Symptoms, Intrusion Frequency, and Intrusion Severity Note. Panel A (top): Intrusion frequency represents the proportion of 2-hour assessment intervals for which patients reported experiencing a cardiac-related intrusive thought of at least moderate severity (intensity score ≥3) (total possible range: 0 to 1). Panel B (bottom): Intrusion severity represents the self-reported intensity score across the two-week recording period (total possible range: 0 to 6 points). These violin plots show the distributions of estimates that define the box plots (horizontal lines represent the 25^th percentile, median, and 75^th percentile) for the elevated and non-elevated PSS groups. Dots and diamonds represent individual elevated- and non-elevated-PSS patients, respectively. Estimates are adjusted for age, sex, GRACE risk score, and Charlson comorbidity index.