Reporting of Posttraumatic Stress Disorder and Cardiac Misconceptions Following Cardiac Rehabilitation

Approximately 15% of cardiac patients experience posttraumatic stress disorder (PTSD), double the incidence seen in the general community. Posttraumatic stress disorder can seriously affect psychological and physical recovery. This study assessed how many patients reported symptoms of PTSD following a cardiac event and examined whether there was any change after completing a cardiac rehabilitation (CR) program. Associations between PTSD and anxiety, depression, and cardiac misconceptions were also explored.

This was a prospective cohort study using repeated measures. All patients eligible for the hospital CR program were invited to complete questionnaires assessing psychological distress and beliefs about heart disease before (T1) and after (T2) completing the CR program.

Questionnaires at T1 were returned by 105 patients. Of these, 24% reported symptoms of PTSD, 18% high anxiety, and 9% high levels of depression. At T2, 67 patients returned questionnaires, showing that 9% of patients continued to experience PTSD. These patients experienced significantly higher levels of anxiety (t = -4.77; P < .001) and depression (t = -3.64; P < .001). Intrusive thoughts and hyperarousal were significantly lower at T2 (t = 2.32; P = .02 and t = 3.01; P = .01, respectively). More misconceptions were associated with higher levels of anxiety and depression; however, the number of cardiac misconceptions remained similar throughout. Caucasians reported significantly fewer misconceptions than non-Caucasian patients, except for beliefs about myocardial infarction. Patients had fewer misconceptions about their own specific condition.

These findings suggest that screening for symptoms of PTSD after completion of a CR program would be helpful in identifying patients who would benefit from specialist psychological support.