AUTHOR=von Känel Roland , Meister-Langraf Rebecca E. , Zuccarella-Hackl Claudia , Znoj Hansjörg , Pazhenkottil Aju P. , Schmid Jean-Paul , Barth Jürgen , Schnyder Ulrich , Princip Mary 

TITLE=Association Between Changes in Post-hospital Cardiac Symptoms and Changes in Acute Coronary Syndrome-Induced Symptoms of Post-traumatic Stress

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.852710

DOI=10.3389/fcvm.2022.852710

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>After acute coronary syndrome (ACS), one in eight patients develops clinically significant symptoms of Post-traumatic stress disorder (PTSD). We hypothesized that changes in cardiac symptoms from 3 to 12 months after ACS are associated with changes in ACS-induced PTSD symptoms.</p></sec><sec><title>Methods</title><p>At 3 (<italic>n</italic> = 154) and/or 12 months (<italic>n</italic> = 106) post-ACS, patients (<italic>n</italic> = 156, mean age 59 years, 85% men) completed a clinical interview assessing chest tightness/pain (at rest and/or during exertion), heartbeat symptoms (heart palpitations, racing of heart, heart stumbling or skipping a beat) and PTSD symptoms during the prior 4 weeks. Random mixed regression models examined the association between the onset (or remission) from 3 to 12 months in cardiac symptoms with changes in PTSD symptoms, adjusting for a range of potential predictors of ACS-induced PTSD symptoms.</p></sec><sec><title>Results</title><p>The onset of chest tightness/pain [estimate = 0.588, 95% confidence interval: 0.275, 0.090; <italic>p</italic> &lt; 0.001] and of heartbeat symptoms [0.548 (0.165, 0.931); <italic>p</italic> = 0.005] from 3 to 12 months was independently associated with an increase in total PTSD symptoms. There were also independent associations between the onset of chest tightness/pain and heartbeat symptoms with an increase in PTSD symptom clusters. Specifically, the onset of chest tightness/pain showed associations with an increase in re-experiencing [0.450 (0.167, 0.733); <italic>p</italic> = 0.027] and avoidance/numbing [0.287 (0.001, 0.574); <italic>p</italic> = 0.049]. The onset of heartbeat symptoms showed associations with an increase in re-experiencing [0.392 (0.045, 0.739); <italic>p</italic> = 0.002], avoidance/numbing [0.513 (0.161, 0.864); <italic>p</italic> = 0.004] and hyperarousal [0.355 (0.051, 0.659); <italic>p</italic> = 0.022]. An increase in the total number of cardiac symptoms (score range 0–6) was also associated with an increase in total PTSD symptoms [0.343 (0.202, 0.484); <italic>p</italic> &lt; 0.001]. Psychotherapy in the post-hospital period moderated the association between the change in heartbeat symptoms and the change in total PTSD symptoms [−0.813 (−1.553, −0.074); <italic>p</italic> = 0.031 for interaction]; the association between the onset of heart beat symptoms and an increase in total PTSD symptoms was weaker in patients who attended psychotherapy [0.437 (−0.178, 1.052); <italic>p</italic> = 0.16] than in those who did not [0.825 (0.341, 1.309); <italic>p</italic> &lt; 0.001].</p></sec><sec><title>Conclusion</title><p>Changes in cardiac symptoms between 3 and 12 months after hospitalization are associated with changes in ACS-induced PTSD symptoms. <ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link> #NCT01781247.</p></sec>