Trajectories of posttraumatic stress in patients with confirmed and rule-out acute coronary syndrome.

Abstract

Many patients evaluated in the emergency department (ED) for acute coronary syndrome (ACS) develop posttraumatic stress symptoms (PTSS), but little is known about symptom trajectories over time. We estimated longitudinal trajectories of PTSS from ED to 1\u202fyear after evaluation for suspected ACS (N\u202f=\u202f1000), and the effect of threat perceptions and discharge diagnosis. Participants reported on threat perceptions in the ED, ongoing cardiac threat at 1\u202fmonth, and PTSS at 1, 6, and 12\u202fmonths. Latent growth mixture modeling identified 3 PTSS trajectories over 1 year: Resilient (81.75%), Chronic-Worsening (13.69%), and Acute-Recovering (4.56%). Chronic-Worsening and Acute-Recovering classes reported significantly higher ED and cardiac threat perceptions than Resilient class. Discharge diagnosis did not differ (χ2(2)\u202f=\u202f2.93, p\u202f=\u202f.231). PTSS are common following evaluation for suspected ACS, and trajectories vary, but targeting threat perceptions may reduce PTSS and improve clinical course, whether or not patients are ultimately diagnosed with ACS.