Cardiac event-induced PTSD symptoms and continuous heart rate in coronary artery disease patients

Elevated posttraumatic stress symptoms (PSS) impact ∼13% of coronary artery disease patients after acute cardiac events and may increase the risk of recurrent events through elevated heart rate (HR), driven by high sympathetic nervous system activity. We investigated whether PSS assessed with the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5 (PCL-5) are associated with elevated ambulatory HR in recently discharged cardiac patients, independent of PSS-linked health behaviors.

Participants (N = 116; 34.4% women, 74% Hispanic, M_age = 61 years) with elevated (PCL-5 ≥ 20, n = 42) or nonelevated (PCL-5 ≤ 5, n = 74) PSS wore 24-hr electrocardiography monitors and wrist actigraphy for 2 weeks, with beta-blocker adherence electronically tracked.

Although the elevated PSS group's mean HR was not significantly higher (3.50 beats per minute, p = .10), each 10-point increase in continuous PSS was significantly associated with 1.6 beats per minute higher HR, p = .009. This effect remained after adjusting for diurnal HR variation, age, sex, cardiac risk score, medical comorbidities, and three objectively estimated, PSS-linked health behaviors relevant to HR-physical activity, sleep episode length, and beta-blocker adherence.

Findings suggest the potential value of targeting postcardiac event PSS to mitigate chronic sympathetic arousal. The use of intensive monitoring and high-resolution behavioral data strengthens the evidence for a physiological pathway linking psychological distress to elevated HR in cardiac patients. (PsycInfo Database Record (c) 2026 APA, all rights reserved).