Background: An aortic disease diagnosis can be perceived by patients as a stressful and often life-altering event. In addition, an acute event, such as aortic rupture or dissection—and the surgical intervention that will be required to address it—can be viewed as potentially life-threatening and traumatic. Serious health conditions, including stroke and acute coronary syndromes, have been described in the literature to correlate with trauma-like symptoms. Post-traumatic stress disorder (PTSD) is well described in connection with external traumatic events, such as war, assault and similarly catastrophic events. A key element of this type of PTSD is that its occurrence arises secondary to an external traumatizer. However, recent work has suggested that internal events—such as a catastrophic medical event (e.g., acute cardiovascular event and/or surgery)—can trigger PTSD symptoms. An important question is whether medical event-initiated PTSD can (or should) be treated similarly to traditionally defined PTSD, when the triggering threat may persist rather than having been confined to a past event. This systematic review will summarize the literature on the occurrence of PTSD as a consequence of an acute cardiovascular event and attempt to identify effective treatments using meta-analysis, if the literature quantity and quality support it. Methods: The search strategy will include publicly available electronic databases, including MEDLINE via PubMed and OVID, EMBASE via Elsevier, Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost, SCOPUS, PsychInfo, and the Cochrane Library, to identify publications that report the development and/or treatment of PTSD as a consequence of an acute cardiovascular event, which include cardiac arrest, acute coronary syndromes, and acute aortic syndromes. Identification of publications, article classification, methodological review/quality assessment, and data extraction will be performed by two trained experts in cardiovascular epidemiology, with the resolution of disagreements carried out by a third independent reviewer. The review conduct and meta-analysis will follow PRISMA and MOOSE guidelines. Data will be aggregated using random effects models when quantitative data are reliable and heterogeneity is reasonable. If a quantitative synthesis is not possible due to data quality, a narrative synthesis will be conducted. Statistical heterogeneity will be assessed by I2 statistics. The quality of evidence will be assessed using the GRADE criteria. Ethics and Dissemination: This study did not require an institutional review board or human subjects protection committee approval given the nature of the study design. The results will be published in a peer-reviewed journal, along with recommendations for future research.
Sandhu et al. (Tue,) studied this question.