Predicting post-traumatic symptoms in cardiac patients

The purpose of this study was to identify correlates and predictors of the symptoms of post-traumatic stress disorder (PTSD) in a cohort of patients with myocardial infarction, while the patients were in hospital and 3 months after infarction.

Longitudinal, consecutive referrals were used.

From a possible 68 consecutive patients with a first myocardial infarction who completed questionnaires in hospital and survived to 3-month follow-up, 39 completed follow-up questionnaires.

PTSD measures were taken in hospital and 3 months after discharge. Predictor variables were measures of mood taken in hospital and measures of the immediate cognitive and emotional reactions at the time of the infarct.

Associations between the independent variables and PTSD symptoms were stronger at 3-month follow-up than while in hospital. At this time, the frequency of intrusive thoughts was predicted by the degree of fright at the time of the event (adjusted R(2) = 0.262; beta =.57; t = 3.30; P <.01) and positive affect scores (additional adjusted R(2) = 0.112; beta = -.37 t = -2.18; P <.05). The degree of physiologic arousal at the time of such flashbacks was predicted by levels of negative affect in hospital (adjusted R(2) = 0.174; beta =.46; t = 2.46; P <.05), which also predicted avoidance scores (adjusted R(2) = 0.203; beta =.48; t = 2.62; P <.05).

Because many of the symptoms of PTSD are self-remitting, and intervening too early in the course of the disorder may exacerbate the disorder, it is important not to intervene too early or over-treat this disorder. Formal treatment may be useful if provided some months after discharge from hospital. If either secondary or primary care services are to treat myocardial infarction-related PTSD effectively, it is important to identify patients who are at risk for it. These data contribute to the development of a profile of patients at risk.