Posttraumatic stress, nonadherence, and adverse outcome in survivors of a myocardial infarction.
OBJECTIVE
Posttraumatic stress disorder (PTSD) symptoms have been reported in patients with coronary vascular disease, after the trauma of a myocardial infarction (MI). The effect of these symptoms on post-MI disease control has not been elucidated. We conducted a study that sought to determine whether PTSD symptoms post-MI are associated with increased likelihood of cardiovascular readmission and with nonadherence to treatment recommendations.


METHODS
Patients were recruited during a visit in a cardiology clinic 6 months post-MI and were followed for 1 year. Adherence to aspirin was measured by platelet thromboxane production (an indication of aspirin's effect). Medical outcome was measured as rate of admission due to cardiovascular causes during the follow-up period. Self-report measures of PTSD (Impact of Event Scale), Depression, and Global Distress (SCL-90-R) were administered at enrollment.


RESULTS
Seventy-three patients were studied. Above-threshold PTSD symptom scores at enrollment, but not depression or global distress scores, were significant predictors of nonadherence to aspirin and of an increased likelihood of cardiovascular readmission over the course of the following year.


CONCLUSIONS
PTSD symptoms predicted poor disease control in this cohort of MI survivors. The data suggest that screening MI survivors for symptoms of PTSD may be beneficial if this high-risk population is to be targeted for interventions.
Department of Psychiatry, Mount Sinai Medical Center, Box 1230, 1 Gustave L. Levy Place, New York, NY 10029, USA. eyal.shemesh@mssm.edu
Eyal
E
Shemesh
Rachel
R
Yehuda
Olga
O
Milo
Irit
I
Dinur
Abraham
A
Rudnick
Zvi
Z
Vered
Gad
G
Cotter
D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D010555:Personality Inventory; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016019:Survival Analysis; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D013931:Thromboxanes / Q000097:blood; D016896:Treatment Outcome; D016312:Treatment Refusal
D010975:Platelet Aggregation Inhibitors; D013931:Thromboxanes; D001241:Aspirin