PTSD After Cardiac Arrest Predicts More Heart Trouble

In Brief

Survivors of cardiac arrest are more likely to experience further heart trouble—and even death—if they have symptoms of PTSD when discharged from the hospital, according to a new study from researchers at Columbia University Irving Medical Center.

“Because nearly a third of cardiac arrest survivors in our study reported PTSD symptoms, finding treatments that diminish the impact of PTSD symptoms is critical to improving outcomes in survivors,” says study leader Sachin Agarwal, MD, MPH, assistant professor of neurology at Columbia University Vagelos College of Physicians and Surgeons and a critical care neurologist at NewYork-Presbyterian.

 

Background

Until recently, few people survived cardiac arrest. But in the past decade, survival has doubled to around 50,000 people each year, due to improvements in medical treatment and increasing use of CPR and defibrillators by bystanders to shock the heart back to a normal rhythm.

Clinicians do not know the psychological consequences of cardiac arrest, as researchers have only recently come to expect that cardiac arrest patients will survive neurologically intact. 

There are currently no clinical guidelines for identifying or treating the psychological consequences of cardiac arrest, because there have been no studies to provide evidence to support such guidelines.

 

What the Study Found

The researchers screened 114 cardiac arrest survivors for PTSD symptoms when the survivors were discharged from the hospital, about three weeks after the arrest. They followed up with the patients one year later. 

Nearly one-third of patients screened positive for PTSD symptoms at hospital discharge, and most of those who survived to six months screened positive for PTSD at the six-month assessment. 

PTSD induced by cardiac arrest was associated with a tripling of risk for death or serious cardiovascular problems necessitating hospitalization in the year following hospital discharge compared with patients without symptoms.

 

Why the Study Is Important

This study is the first to look at a potential connection between PTSD symptoms detected at hospital discharge and subsequent cardiovascular events and mortality in cardiac arrest survivors. 

Sachin Agarwal, MD, Columbia University critical care neurologist
Sachin Agarwal

The findings of the current research will form the foundation for future guidelines to improve care for cardiac arrest survivors through improved detection and management of PTSD caused by the arrest.

 

What’s Next

The researchers are now looking at the physiological and behavioral mechanisms underlying the relationship between PTSD and subsequent cardiovascular disease.  

Their ultimate goal is to develop treatments that can be given to patients with PTSD symptoms before hospital discharge or before these symptoms develop. 

References

The study, titled “Cardiac arrest and the subsequent hospitalization-induced posttraumatic stress is associated with 1-year risk of major adverse cardiovascular events and all-cause mortality,” was published online March 19 in Critical Care Medicine. 

Dr. Agarwal received a 2018 Young Investigator Award at the American Heart Association annual meeting for a presentation of this work. The research is based on data collected from his NeuroCardiac Comprehensive Care Clinic at Columbia University Irving Medical Center and NewYork-Presbyterian.

Other authors: Alex Presciutti, Talea Cornelius, Jeffrey Birk, David J. Roh, Soojin Park, Jan Claassen, Mitchell S.V Elkind, and Donald Edmondson (all from Columbia University Irving Medical Center).

The study was supported by institutional funds provided to Dr. Agarwal. 

The authors report no conflicts of interest.