Post-Traumatic Stress Disorder Severity and Cardiac Rehabilitation Utilization Following Myocardial Infarction

Post-traumatic stress disorder (PTSD) is associated with poor health behaviors and risk for cardiovascular disease, and PTSD may impair cardiovascular disease recovery. Whether PTSD severity is a barrier to cardiac rehabilitation (CR) use following a new myocardial infarction (MI) or revascularization (percutaneous coronary intervention or coronary artery bypass grafting) is uncertain.

Eligible patients were identified from Veterans Health Administration historical medical record data. Patients (N = 5170) had 1 or more PTSD diagnoses and ≥1 PTSD Checklist score between October 1, 2011, and September 30, 2022. Modified Poisson models with robust error variance were computed before and after adjusting for covariates to measure the association between PTSD severity and any CR use in the 12 months after MI/revascularization. Among those who used CR, we determined if PTSD severity was linked to receiving 9 or more sessions.

The sample was an average 62.1 ± 11.0 years of age, 95% male, and 77% identified as White race. During the 12-month follow-up period, 8% of the sample had any CR, and among those who did, 66% had ≥9 visits. The severity of PTSD was not significantly associated with any CR use nor with receipt of 9 or more encounters.

Participation in CR was low regardless of PTSD severity. Although it is encouraging that higher PTSD severity is not a barrier to CR participation, increasing engagement of veterans in CR after MI/revascularization will be important for reducing their risk of recurrent events and mortality.