The goal of this ancillary study is to identify a target for intervention after an acute coronary syndrome (ACS) that may decrease risk for recurrent cardiac events and mortality among patients who develop posttraumatic stress disorder (PTSD) due to the ACS. Approximately 12% of the nearly 2 million Americans who survive an ACS each year develop PTSD. Compared to ACS survivors who do not develop PTSD, those with PTSD have double the risk of recurrent cardiovascular events and mortality. The mechanisms underlying the association between ACS-induced PTSD and poor cardiovascular prognosis remain unknown. As a result, there is need for studies that assess mechanisms explaining the association between PTSD and prognosis. A hallmark of PTSD is avoidance of exposure to reminders of the traumatic event. This has led to the hypothesis that ACS-survivors with PTSD will poorly adhere to medications that serve as reminders of the traumatic cardiac event. In support of this hypothesis, we have shown that stroke survivors with PTSD are three times as likely to report being non-adherent to their medications. Yet, thus far, no one has assessed whether ACS-induced PTSD is associated with poor medication adherence. If ACS-induced PTSD results in poor adherence to cardioprotective medications, then medication adherence may represent an important target for improving prognosis in ACS-survivors with PTSD. The NHLBI-funded study Impact of Social-Interpersonal Factors in the ER on PTSD/Cardiac Outcomes provides a unique opportunity to test these hypotheses. This parent study will enroll a cohort of 1,741 ACS patients who initially present to the emergency room (ER) and are followed for 12 months to determine 1) which ER factors contribute to the development of PTSD after ACS and 2) the association between ACS- induced PTSD at 1 month and prognosis 1 year after the index ACS event. In this ancillary study, we propose to additionally measure adherence to aspirin in the six months after ACS using the gold-standard approach - electronic monitoring. We will also survey participants to understand why ACS-induced PTSD is associated with poor medication adherence. Finally, we will test whether the association between ACS-induced PTSD and ACS recurrence/mortality will be diminished after controlling for medication adherence. The results from this study will contribute to the understanding of the mechanisms by which ACS-induced PTSD leads to poor prognosis and will identify a specific target for interventions to improve prognosis in ACS survivors with PTSD.

Public Health Relevance

One out of every eight survivors of acute coronary syndromes (ACS) develops posttraumatic stress disorder (PTSD) due to the cardiac event. ACS-survivors with PTSD are at double the risk of having another ACS or dying. The mechanisms by which PTSD worsens prognosis remain unknown. This study will assess the association between ACS-induced PTSD and medication adherence and will determine whether poor medication adherence should be an important target for improving prognosis in ACS survivors with PTSD. (End of abstract)

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL123368-03
Application #
9086418
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Stoney, Catherine
Project Start
2014-08-15
Project End
2018-06-30
Budget Start
2016-07-01
Budget End
2017-06-30
Support Year
3
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Columbia University (N.Y.)
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Kronish, Ian M; Edmondson, Donald; Moise, Nathalie et al. (2018) Posttraumatic stress disorder in patients who rule out versus rule in for acute coronary syndrome. Gen Hosp Psychiatry 53:101-107
St Onge, Tara; Edmondson, Donald; Cea, Emily et al. (2018) Depressive Symptoms and Perceptions of ED Care in Patients Evaluated for Acute Coronary Syndrome. J Emerg Nurs 44:46-51
Cornelius, Talea; Meli, Laura; Thorson, Katherine R et al. (2018) Bringing close others to the emergency department for an acute coronary event is associated with increased patient perception of threat. Gen Hosp Psychiatry 56:42-49
Cornelius, Talea; Voils, Corrine I; Birk, Jeffrey L et al. (2018) Identifying targets for cardiovascular medication adherence interventions through latent class analysis. Health Psychol 37:1006-1014
Cornelius, Talea; Moise, Nathalie; Birk, Jeffrey L et al. (2018) The presence of companions during emergency department evaluation and its impact on perceptions of clinician-patient communication. Emerg Med J 35:701-703
Shaffer, Jonathan A; Kronish, Ian M; Falzon, Louise et al. (2018) N-of-1 Randomized Intervention Trials in Health Psychology: A Systematic Review and Methodology Critique. Ann Behav Med 52:731-742
Monane, Rachel; Sanchez, Gabriel J; Kronish, Ian M et al. (2018) Post-traumatic stress disorder symptoms and aversive cognitions regarding physical activity in patients evaluated for acute coronary syndrome. Eur J Prev Cardiol 25:402-403
Zhu, Deanna R; Julian, Jacob; Lee, Sung J A et al. (2018) Patterns of peritraumatic threat perceptions in patients evaluated for suspected acute coronary syndrome according to prior and current posttraumatic stress symptoms. Gen Hosp Psychiatry 53:119-124
Taggart Wasson, Lauren; Shaffer, Jonathan A; Edmondson, Donald et al. (2018) Posttraumatic stress disorder and nonadherence to medications prescribed for chronic medical conditions: A meta-analysis. J Psychiatr Res 102:102-109
Husain, S Ali; Edmondson, Donald; Kautz, Marin et al. (2018) Posttraumatic stress disorder due to acute cardiac events and aversive cognitions towards cardiovascular medications. J Behav Med 41:261-268

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