TY - JOUR
T1 - Posttraumatic stress disorder in patients who rule out versus rule in for acute coronary syndrome
AU - Kronish, Ian M.
AU - Edmondson, Donald
AU - Moise, Nathalie
AU - Chang, Bernard P.
AU - Wei, Ying
AU - Veneros, David Lopez
AU - Whang, William
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Objective: Many patients who present to the emergency department (ED) with acute coronary syndromes (ACS) develop posttraumatic stress disorder (PTSD) due to the experience. Less is known about risk for PTSD in patients who rule out for ACS. Our objective was to compare the risk of developing PTSD among patients who rule out versus rule in for ACS. Methods: We enrolled a consecutive sample of 1000 patients presenting to an emergency department (ED) with symptoms of a probable ACS. We assessed presenting ACS symptoms in the ED. We determined whether presenting symptoms were due to a confirmed ACS or another etiology by chart review. We assessed PTSD by telephone 1 month after discharge using the PTSD Checklist specific for the suspected ACS event (PCL-S). We used logistic regression to determine the association of ruling out versus ruling in for ACS with a positive PTSD screen (PCL-S ≥ 32), adjusting for demographics, comorbidities, depression, trauma history, and pre-existing PTSD. Results: Approximately two-thirds of patients (68.2%) ruled out for ACS. Compared to confirmed ACS patients, patients who ruled out had similar presenting symptoms, and similar risk of screening positive for PTSD (18.9% versus 16.8%; p = 0.47; adjusted OR 1.18, 95% CI 0.69–2.00; p = 0.55). Conclusions: ED presentation with ACS symptoms was sufficient to trigger a positive PTSD screen whether the etiology was due to a life-threatening ACS or another etiology. Patients who present with ACS symptoms should be considered for interventions to prevent PTSD after hospitalization, regardless of symptom etiology.
AB - Objective: Many patients who present to the emergency department (ED) with acute coronary syndromes (ACS) develop posttraumatic stress disorder (PTSD) due to the experience. Less is known about risk for PTSD in patients who rule out for ACS. Our objective was to compare the risk of developing PTSD among patients who rule out versus rule in for ACS. Methods: We enrolled a consecutive sample of 1000 patients presenting to an emergency department (ED) with symptoms of a probable ACS. We assessed presenting ACS symptoms in the ED. We determined whether presenting symptoms were due to a confirmed ACS or another etiology by chart review. We assessed PTSD by telephone 1 month after discharge using the PTSD Checklist specific for the suspected ACS event (PCL-S). We used logistic regression to determine the association of ruling out versus ruling in for ACS with a positive PTSD screen (PCL-S ≥ 32), adjusting for demographics, comorbidities, depression, trauma history, and pre-existing PTSD. Results: Approximately two-thirds of patients (68.2%) ruled out for ACS. Compared to confirmed ACS patients, patients who ruled out had similar presenting symptoms, and similar risk of screening positive for PTSD (18.9% versus 16.8%; p = 0.47; adjusted OR 1.18, 95% CI 0.69–2.00; p = 0.55). Conclusions: ED presentation with ACS symptoms was sufficient to trigger a positive PTSD screen whether the etiology was due to a life-threatening ACS or another etiology. Patients who present with ACS symptoms should be considered for interventions to prevent PTSD after hospitalization, regardless of symptom etiology.
KW - Acute coronary syndrome
KW - Cardiovascular disease
KW - Emergency department
KW - Etiology
KW - Posttraumatic stress disorder
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85047069972&partnerID=8YFLogxK
U2 - 10.1016/j.genhosppsych.2018.02.007
DO - 10.1016/j.genhosppsych.2018.02.007
M3 - Article
C2 - 29773309
AN - SCOPUS:85047069972
SN - 0163-8343
VL - 53
SP - 101
EP - 107
JO - General Hospital Psychiatry
JF - General Hospital Psychiatry
ER -