Heart attacks may lead to PTSD, analysis finds

Posttraumatic stress disorder (PTSD) is relatively common among survivors of acute coronary syndrome (ACS) and is associated with worse outcomes, according to a new meta-analysis.
The analysis covered 24 observational cohort studies including more than 2,000 patients who had ACS and were assessed for PTSD at least one month after the event. Overall, 12% of the patients had clinically significant symptoms of PTSD (95% CI, 9% to 16%), although rates varied widely among the studies. The variation could be explained by differing methods of screening, authors said; studies that used a screening questionnaire found higher rates of PTSD than those that used diagnostic interviews.
Three of the studies, totaling about 600 patients, assessed the relationship between PTSD and negative outcomes (mortality and/or ACS recurrence). Combined, the studies indicated a doubling of risk for these negative outcomes associated with clinically significant symptoms of PTSD (risk ratio, 2.00; 95% CI, 1.69 to 2.37). The overall meta-analysis also found that younger age was associated with higher PTSD rates, while a more recent study publication date was associated with lower risk (perhaps due to advances in treatment, the authors said). The results were published in the June PLoS One.
Extrapolating from their findings, study authors calculated that 168,000 ACS patients in the U.S. may develop PTSD each year. Their risk for mortality and recurrence is similar to the increased risk faced by depressed patients, they noted. Although the mechanism for this relationship is not known, increased inflammation associated with PTSD may have a negative effect on the heart, the authors speculated.
They called for additional research into treatments for ACS-induced PTSD, noting that only one treatment study (a trial of cognitive behavioral therapy) was identified in their search. A unified risk stratification strategy, using previously identified risk factors, is also needed, they concluded.