title: Post-traumatic stress disorder (PTSD) symptoms predict delay to hospital in patients with acute coronary syndrome.
abstract: BACKGROUND
  Increased delay to hospital presentation with acute coronary syndrome (ACS) is associated with poor outcomes. While demographic factors associated with this delay have been well described, scarce data are available on the role of modifiable factors, such as psychosocial disorders, on pre-hospital delay. Patients with symptoms of post-traumatic stress disorder (PTSD) often avoid stressful situations and may delay presenting for care when they experience cardiac symptoms. It is unknown, however, whether PTSD symptoms negatively impact the time to presentation during an ACS.
  
  
  METHODS
  We assessed the relationship between PTSD symptoms and pre-hospital delay in 241 adults with an ACS in the ongoing Prescription Use, Lifestyle, Stress Evaluation (PULSE) study.
  
  
  RESULTS
  Overall, 66% of patients were male; 40% were Hispanic or Latino. The mean age was 61.9±11.6 years old. PTSD symptoms were present in 17.8% of patients. Pre-hospital delay was longer for patients with PTSD symptoms compared to those without [geometric mean: 25.8 hours (95% CI 13.8-44.8) vs. 10.7 hours (95% CI 8.3-13.8)]; P = 0.005. After multivariable adjustment for age, sex, ethnicity, depression, left ventricular ejection fraction and history of myocardial infarction, the mean pre-hospital delay was 173% (95% CI: 36%-450%) longer for patients with versus without PTSD symptoms.
  
  
  CONCLUSIONS
  Among patients presenting with an ACS, PTSD symptoms were independently associated with longer pre-hospital delays. Future studies of pre-hospital delay should examine the mechanisms underlying this association.
authors.affiliation: Department of Medicine, Columbia University Medical Center, Columbia University, New York, New York, United States of America.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Newman
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
mesh_terms: D054058:Acute Coronary Syndrome; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic; D013997:Time Factors
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