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Posttraumatic Stress Disorder and Electronically Measured Medication Adherence After Suspected Acute Coronary Syndromes

Year: 2020

Type: article

Abstract: hypertension ◼ medication adherence ◼ posttraumatic stress disorder T he experience of a suspected acute coronary syndrome (ACS) can induce symptoms of posttraumatic stress disorder (PTSD), even among patients who rule out for ACS. 1 Patients who develop PTSD symptoms after ACS have twice the risk for recurrent cardiovascular events and mortality.2 Yet the reasons for this association between ACS-induced PTSD symptoms and adverse prognosis are poorly understood.A hallmark of PTSD is avoidance of reminders of traumatic events.Patients with ACS-induced PTSD report skipping cardiovascular medications because they serve as traumatic reminders.3 Self-reported adherence, however, is a poor indicator of true medication-taking behavior.4 This study is the first to test whether suspected ACS-induced PTSD symptoms are associated with electronically monitored medication nonadherence.From 2014 to 2017, we enrolled a cohort of patients with suspected ACS from the emergency department of Columbia University Irving Medical Center.5 Patients were included in this adherence substudy if they were prescribed a cardiovascular medication at discharge.Patients were excluded if they were non-English-or non-Spanish-speaking, cognitively impaired, in need of psychiatric intervention, terminally ill, or incapable of using an electronic pill bottle.The Columbia University Irving Medical Center institutional review board approved the protocol.All patients provided written informed consent.PTSD was evaluated by telephone 1 month after discharge using the 17-item PTSD Checklist for a specific stressor (PCL-S), cued to the ACS symptoms that brought patients to the emergency department.A PCL-S score of 30 has ≈80% sensitivity and specificity for PTSD diagnosis in primary care, and a score ≥44 is consistent with probable PTSD.Adherence to a single cardiovascular medication (typically aspirin) was assessed for up to 3 months after discharge using eCAPs (Information Mediary Corp, Ottawa, Canada).eCAPs resemble ordinary pill bottle caps but record the date and time when pill bottles are opened.Substudy participants transferred their monitored medication into an eCAP mailed to their address after hospital discharge and mailed back the eCAP after a follow-up phone call.Generalized estimating equations were used to model the percentage of adherent days per month (ie, days adherent/days monitored) from PTSD symptoms.Month was a repeated-measures factor.Covariates included age, sex, ethnicity, discharge diagnosis (ACS confirmed or ruled out), comorbidity (Charlson score), depression (8-item Patient Health Questionnaire), and dosing frequency of monitored medication.Of 783 eligible patients, 662 (84.5%) agreed to participate, 474 (60.5%) returned eCAPs, and 400 (51.1%) had complete data on covariates and were included in these analyses.Patients with greater PTSD symptoms were less likely to return eCAPs (P=0.03).

Source: Circulation

DOI: 10.1161/circulationaha.120.045714