June 20, 2012 -- A heart attack is a traumatic event, physically and emotionally, but cardiologists don't pay enough attention to post-traumatic stress disorder among their patients, according to the author of a new study.
Not only does the disorder occur in 1 out of 8 such patients, the study shows PTSD also doubles a patient's risk of having another heart attack or dying.
"If it's a month after the heart attack and the patient is still preoccupied with memories of the heart attack, and they find those memories very disturbing (i.e., they are accompanied by increased heart rate, nervousness, anxiety), or if they're having nightmares about the heart attack, those are signs that PTSD may be an issue. Similarly, if the patient absolutely does not want to think or talk about the heart attack because it makes them too anxious, that's another sign to watch out for," says Donald Edmondson, PhD, an assistant professor of behavioral medicine at Columbia University Medical Center in New York City.
Edmondson and his colleagues combed through the scientific literature for studies linking PTSD and acute coronary syndromes (ACS), such as heart attack and unstable angina, in which blood flow to the heart is suddenly blocked. They found 24 such studies with a total of 2,383 patients, of which 12% either developed PTSD or experienced symptoms that impaired their functioning in daily life.
Three of the studies they reviewed looked at the outcomes of ACS patients with PTSD. Together, the results of those studies, which included more than 600 participants, showed that patients suffering from the disorder after a heart attack were twice as likely to have another serious heart event or to die within approximately two years.
PTSD affects an estimated 5.2 million people each year, according to the National Center for PTSD, and 7%-8% of the population will have PTSD sometime during their lives. Those considered at risk for the disorder include soldiers and civilians who have experienced war, sexual assault survivors, and people who have been involved in -- or who have witnessed -- life-threatening events such as serious car accidents or a natural disaster.
People with the disorder often have nightmares or flashbacks to the traumatic event. They may lose interest in things they used to enjoy and feel numb. And they may have trouble sleeping or controlling their temper.
Addressing PTSD Among Heart Patients
Edmondson, who says that the disorder is highly treatable, would like to see cardiologists screen their patients for PTSD, which he says can be done reliably and quickly with a four-item questionnaire.
"It takes next to no time," says Edmondson. "They are already screening for depression, so why not throw in these four questions?"
David Frid, MD, a cardiologist at the Cleveland Clinic who was not involved in the research, says the study is a "nice initial look at the issue." Although more needs to be learned about the connection between PTSD and heart attack, Frid says the study has raised his awareness of the potential problem.
"If somebody is experiencing symptoms associated with PTSD, such as difficulty sleeping, problems with moving on from the event, and worrying about what happened, they should discuss it with their cardiologist or primary care provider or seek an evaluation from a mental health professional to see if PTSD is the cause," says Frid.
"Treatment for PTSD can have a positive impact, but first we have to find out why they can't get back to where they should be. Patients need to be their own advocates, but family members may need to be proactive and have a discussion with his or her health care provider."
Cardiologist Saurabh Gupta, MD, agrees.
"Based on this study, if I recognize the cues, I will be more vigilant," says Gupta, who practices at Oregon Health and Science University in Portland.
Gupta, who reviewed the study for WebMD, would also like to see more research before making any real changes to his practice.
"This is a hypothesis-generating study," he says.
PTSD, says Edmondson, is a quality-of-life problem. For people with ACS, though, it is also a quantity of life and hospitalization issue.
"These patients are not just unable to enjoy life, they are at risk of further hospitalizations and death," he says. "Paying attention to PTSD is a no-brainer."