Tuesday, 2 September 2014

Objectives: Although guidelines recommend the assessment of psychological factors in cardiac patients, the screening of posttraumatic stress disorder (PTSD) after acute coronary syndrome (ACS) is not systematically done in clinical practice. Assessing fear of dying at hospitalization might be a pragmatic approach to identify patients at risk of developing PTSD. Methods: We enrolled 90 patients hospitalized with a diagnosis of ACS in a Cardiology University Clinic from February to June 2012. At baseline, we collected data on fear of dying, feeling of helplessness, anxiety and coping capacities. One month after discharge, we measured PTSD using the posttraumatic stress scale. Using logistic regression, we estimated age and gender adjusted odds ratios (OR) and 95% confidence intervals (CI) of the associations between baseline psychological factors and the occurrence of PTSD. Results: 24 patients (26.7%) developed PTSD one month after the ACS event. Patients who developed PTSD reported significantly greater fear of dying (adjusted OR 3.78, 95% CI 1.39-10.31) and helplessness (OR 4.29, 95% CI 1.50-12.22) at the index hospitalization. The fear of dying was associated with high degree of severe anxiety (P=0.002) and maladaptive coping capacities (P value=0.056). Conclusion: The fear of dying during the hospitalization is associated with the occurrence of PTSD in patients with ACS. A simple question about fear of dying might be useful to identify patients at higher risk for PTSD. Further studies are needed to assess the impact of interventions based on improving coping strategies in those patients.