PTSD, Medication Adherence, and Prognosis after Acute Coronary Syndromes

描述（由申请方提供）：本辅助研究的目的是确定急性冠状动脉综合征（ACS）后的干预靶点，该靶点可降低因ACS而发生创伤后应激障碍（PTSD）的患者的复发性心脏事件和死亡率风险。每年在ACS中幸存的近200万美国人中，约有12%发展为PTSD。与未发生PTSD的ACS幸存者相比，PTSD患者复发心血管事件和死亡率的风险增加一倍。ACS诱导的PTSD与心血管预后不良之间的相关机制尚不清楚。因此，有必要进行研究，评估机制解释创伤后应激障碍和预后之间的关联。PTSD的一个标志是避免暴露于创伤事件的提醒。这导致了一种假设，即患有PTSD的ACS幸存者对作为创伤性心脏事件提醒的药物的依从性较差。为了支持这一假设，我们已经表明，患有创伤后应激障碍的中风幸存者报告不依从药物治疗的可能性是其他患者的三倍。然而，到目前为止，还没有人评估ACS引起的PTSD是否与药物依从性差有关。如果ACS诱导的PTSD导致对心脏保护药物的依从性差，那么药物依从性可能是改善ACS幸存者PTSD预后的重要目标。NHLBI资助的研究“急诊室社会人际因素对PTSD/心脏结局的影响”提供了一个独特的机会来检验这些假设。这项母研究将招募1，741名ACS患者的队列，这些患者最初到急诊室（ER）就诊，并随访12个月，以确定1）哪些ER因素有助于ACS后PTSD的发展，以及2）ACS诱导的PTSD在1个月时与ACS指数事件后1年的预后之间的关联。在这项辅助研究中，我们建议使用金标准方法-电子监测来额外测量ACS后6个月内阿司匹林的依从性。我们还将调查参与者，以了解为什么ACS引起的PTSD与药物依从性差有关。最后，我们将测试ACS诱导的PTSD和ACS复发/死亡率之间的关联是否会在控制药物依从性后减少。本研究的结果将有助于理解ACS诱导的PTSD导致预后不良的机制，并将确定一个特定的干预目标，以改善ACS幸存者PTSD的预后。

DESCRIPTION (provided by applicant): The goal of this ancillary study is to identify a target for intervention after an acute coronary syndrome (ACS) that may decrease risk for recurrent cardiac events and mortality among patients who develop posttraumatic stress disorder (PTSD) due to the ACS. Approximately 12% of the nearly 2 million Americans who survive an ACS each year develop PTSD. Compared to ACS survivors who do not develop PTSD, those with PTSD have double the risk of recurrent cardiovascular events and mortality. The mechanisms underlying the association between ACS-induced PTSD and poor cardiovascular prognosis remain unknown. As a result, there is need for studies that assess mechanisms explaining the association between PTSD and prognosis. A hallmark of PTSD is avoidance of exposure to reminders of the traumatic event. This has led to the hypothesis that ACS-survivors with PTSD will poorly adhere to medications that serve as reminders of the traumatic cardiac event. In support of this hypothesis, we have shown that stroke survivors with PTSD are three times as likely to report being non-adherent to their medications. Yet, thus far, no one has assessed whether ACS-induced PTSD is associated with poor medication adherence. If ACS-induced PTSD results in poor adherence to cardioprotective medications, then medication adherence may represent an important target for improving prognosis in ACS-survivors with PTSD. The NHLBI-funded study "Impact of Social-Interpersonal Factors in the ER on PTSD/Cardiac Outcomes" provides a unique opportunity to test these hypotheses. This parent study will enroll a cohort of 1,741 ACS patients who initially present to the emergency room (ER) and are followed for 12 months to determine 1) which ER factors contribute to the development of PTSD after ACS and 2) the association between ACS- induced PTSD at 1 month and prognosis 1 year after the index ACS event. In this ancillary study, we propose to additionally measure adherence to aspirin in the six months after ACS using the gold-standard approach - electronic monitoring. We will also survey participants to understand why ACS-induced PTSD is associated with poor medication adherence. Finally, we will test whether the association between ACS-induced PTSD and ACS recurrence/mortality will be diminished after controlling for medication adherence. The results from this study will contribute to the understanding of the mechanisms by which ACS-induced PTSD leads to poor prognosis and will identify a specific target for interventions to improve prognosis in ACS survivors with PTSD.