The Impact of Cardiac-induced Post-traumatic Stress Disorder Symptoms on Cardiovascular Outcomes: Design and Rationale of the Prospective Observational Reactions to Acute Care and Hospitalizations (ReACH) Study.
The Impact of Cardiac-induced Post-traumatic Stress Disorder Symptoms on Cardiovascular Outcomes: Design and Rationale of the Prospective Observational Reactions to Acute Care and Hospitalizations (ReACH) Study.
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DOI：
10.5334/hpb.16
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Edmondson, Donald
中科院分区：
文献类型：
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作者：
Birk, Jeffrey;Kronish, Ian;Edmondson, Donald
目标：多达八分之一的急性冠状动脉综合征（ACS）患者因ACS而发展为创伤后应激障碍（PTSD），ACS诱导的PTSD可能会增加继发性心血管疾病（CVD）的风险。然而，以前的研究规模小，没有足够的力量来测试假设的PTSD-继发性CVD风险关联的合理行为或生物学机制。在本文中，我们描述了一项大型前瞻性观察性队列研究的设计和方法，以评估ACS诱导的PTSD的预后意义，其与CVD风险相关的机制，以及可能增加PTSD风险的急诊科（艾德）因素，在一个大型城市学术医疗中心的艾德评估急性冠脉综合征（ACS）的患者队列中。急性护理和住院反应（ReACH）研究跟踪了1，741名最初因ACS症状就诊于艾德的种族、民族和社会经济背景不同的患者。在基线时评估心理社会因素。通过电子药瓶（eCAP）监测药物依从性。参与者通过电话联系在1，6，和12个月后住院，以评估创伤后应激障碍症状，再入院，和复发性心血管事件/死亡率（主动搜索和确认的医疗记录）。结论：这项研究将提供最准确的估计，迄今为止的创伤后应激障碍的关联与复发性心血管事件和死亡率，并将测试是否药物依从性介导的关联。此外，它还将提供ACS患者中艾德和医院因素对PTSD风险的贡献的估计。如果我们的假设得到支持，我们将把PTSD确定为降低次级风险的新目标。
AIMS: As many as 1 in 8 acute coronary syndrome (ACS) patients develop posttraumatic stress disorder (PTSD) due to the ACS, and ACS-induced PTSD may increase secondary cardiovascular disease (CVD) risk. However, prior studies have been small and underpowered to test plausible behavioral or biological mechanisms of the hypothesized PTSD-secondary CVD risk association. In this paper, we describe the design and methods of a large prospective observational cohort study to estimate the prognostic significance of ACS-induced PTSD, mechanisms for its association with CVD risk, and emergency department (ED) factors that may increase PTSD risk, in a cohort of patients evaluated for acute coronary syndrome (ACS) in the ED of a large, urban academic medical center.METHODS: The Reactions to Acute Care and Hospitalization (ReACH) study follows 1,741 racially, ethnically, and socioeconomically diverse patients initially presenting to the ED with ACS symptoms. Psychosocial factors are assessed at baseline. Medication adherence is monitored by electronic pill bottle (eCAP). Participants are contacted by phone at 1-, 6-, and 12-months post-hospitalization to assess PTSD symptoms, hospital readmission, and recurrent CVD events/mortality (proactively searched and confirmed by medical records).CONCLUSION: This study will provide the most accurate estimates to date of PTSD's association with recurrent CVD events and mortality and will test whether medication adherence mediates that association. Further, it will provide estimates of the contribution of ED and hospital factors to PTSD risk in ACS patients. If our hypotheses are supported, we will have identified PTSD as a novel target for secondary risk reduction.