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Posttraumatic stress disorder due to acute cardiac events and aversive cognitions towards cardiovascular medications

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Abstract

Posttraumatic stress disorder (PTSD) after acute medical events is associated with medication nonadherence. The mechanisms of PTSD-related nonadherence are poorly understood. We tested whether patients with elevated PTSD symptoms induced by suspected acute coronary syndrome (ACS) were more likely to have aversive cognitions towards cardiovascular medications. We enrolled a consecutive cohort of patients who presented to the emergency department with suspected ACS. One month after discharge, ACS-induced PTSD symptoms were assessed using the PTSD Checklist (PCL-S), and patients were asked “how often did” (1) “you miss your heart medication because you did not want to be reminded about your heart problem”; (2) “thinking about your heart medication make you feel nervous or anxious”; and (3) “thinking about your heart medication make you think about your risk for future heart problems.” Logistic regression was used to determine the association between elevated PTSD symptoms and each aversive cognition, adjusting for age, sex, race, ethnicity, education, depression, and ACS status. Of 424 patients included, 15.8% had elevated PTSD symptoms (PCL-S ≥ 34). In adjusted analyses, higher PCL-S scores were associated with missing medications to avoid reminders of heart disease (OR 1.22 per 5-point PCL-S increase, 95%CI 1.07–1.40), as well as anxiety (OR 1.34, 95%CI 1.19–1.51) and thoughts of future risk (OR 1.19, 95%CI 1.08–1.32) when thinking about cardiovascular medications. We concluded that patients with elevated PTSD symptoms following suspected ACS were more likely to report aversive cognitions about their cardiovascular medications, suggesting that medications can act as traumatic reminders of the cardiac event and ongoing risk in this group.

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Funding

This study was supported by grants from the National Heart, Lung, and Blood Institute (NHLBI) [HL117832 and HL123368]. Dr. Kronish received additional support from NCATS.

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Authors and Affiliations

  1. Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA

    S. Ali Husain, Donald Edmondson, Marin Kautz, Redeana Umland & Ian M. Kronish

  2. Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY, USA

    S. Ali Husain

Authors
  1. S. Ali Husain
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  2. Donald Edmondson
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  3. Marin Kautz
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  4. Redeana Umland
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  5. Ian M. Kronish
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Correspondence to Ian M. Kronish.

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Conflict of interest

The authors S. Ali Husain, Donald Edmondson, Marin Kautz, Redeana Umland, and Ian M. Kronish declare that they have no conflict of interest.

Human and animal rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Husain, S.A., Edmondson, D., Kautz, M. et al. Posttraumatic stress disorder due to acute cardiac events and aversive cognitions towards cardiovascular medications. J Behav Med 41, 261–268 (2018). https://doi.org/10.1007/s10865-017-9906-3

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  • DOI: https://doi.org/10.1007/s10865-017-9906-3

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