Published online Jun 19, 2023. doi: 10.5498/wjp.v13.i6.376
Peer-review started: March 26, 2023
First decision: April 28, 2023
Revised: May 4, 2023
Accepted: May 25, 2023
Article in press: May 25, 2023
Published online: June 19, 2023
Processing time: 84 Days and 15.7 Hours
Acute coronary syndrome (ACS) can be a stressor in the development of posttraumatic stress disorder (PTSD). Patients with PTSD after ACS have worse survival outcomes, and studies report different prevalence rates of PTSD following ACS. It is challenging to identify these patients and prevent their unfavorable outcomes.
Clinicians and cardiologists who deal with cardiac rehabilitation (CR) are increasingly noticing patients with elements of PTSD after ACS. The problem is their poorer outcomes, and CR with a multidisciplinary team (cardiologist, psychiatrist, psychologist) can be a place for early detection and intervention in these patients.
In this study we aim to investigate the prevalence of PTSD after ACS in patients undergoing CR and their demographic, behavioral, and biological characteristics. Identifying patients at risk for persistent and severe ACS-induced PTSD based on these characteristics could facilitate the implementation of early preventive measures.
This is an ongoing prospective analytical case-control study. The study includes patients who have experienced ACS and are enrolled in a 3-wk CR program. A group of patients with PTSD diagnosis was identified using self-assessment questionnaires for PTSD criteria and clinical psychiatric interviews, and a control group was formed based on clinically relevant variables to enable comparison of these patient groups. Medical data were collected, and diagnostic tests were conducted to obtain data on important biological characteristics [laboratory testing, exercise test (ergometry), echocardiogram]. The expected average follow-up period for patients included in the study is approximately 18 mo.
Of 504 patients completed PTSD Checklist-Civilian Version questionnaire and 80 (15.9%) met the cutoff criteria for the PTSD and qualified for further evaluation by psychiatrists. Among them, 51 patients (10.1%) were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria. Among the variables analyzed, there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups. Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group (P = 0.035).
This study found a significant proportion of patients with PTSD induced by ACS (10.1%), and these patients are under-recognized and not appropriately treated. The study also found that patients with PTSD achieved a lower theoretical maximum on exercise testing, suggesting that they may avoid physical activity, which could be one of the underlying mechanisms for the worse cardiovascular outcomes observed in this subpopulation of patients.
Early identification of patients with ACS-induced PTSD and intervention are crucial, and CR provides a unique opportunity for timely recognition and management of high-risk patients, potently leading to improved outcomes. Future research could focus on identifying possible cardiac biomarkers to detect patients at risk of developing PTSD after ACS and apply personalized interventions based on the principle of precision medicine. Multidisciplinary CR programs may be particularly effective in addressing the complex needs of patients with ACS induced PTSD.