Project

Discipline

Posttraumatic stress disorder; Myocardial infarction; Randomized controlled trial; Behavioral intervention; Atherosclerosis; Cardiovascular disease; Psychological stress

Lead
Mit dieser Studie soll untersucht werden, ob ein einmaliges und früh nach dem Herzinfarkt durchgeführtes Beratungsgespräch nach notfallpsychologischen Prinzipien die Entwicklung von posttraumatischem Stress bezogen auf das Infarkterleben, gemessen 3 Monate nach dem Infarkt, zu reduzieren vermag.
Lay summary
Inhalt und Ziele des Forschungsprojekts Nach einem Herzinfarkt entwickelt einer von sechs Patienten eine posttraumatische Belastungsstörung (PTBS), welche durch verschiedene Symptome charakterisiert ist. Dazu gehören das Wiedererinnern an den Infarkt (z.B. das automatische Ablaufen eines inneren Films), Handlungen, die das Wiedererinnern vermeiden sollen (z.B. nicht über den Infarkt sprechen wollen) und Beschwerden von erhöhter psychischer Anspannung wie Gereiztheit und gestörter Schlaf. Posttraumatische Stresssymptome verschlechtern die Prognose des Herzinfarkts und erhöhen das Risiko für eine erneute Hospitalisierung wegen einem Herzkreislauf-Problem. In der Notfallpsychologie werden nach Verkehrsunfällen und anderen Katastrophen früh sogenannte „Care Teams“ eingesetzt, welche die Betroffenen bei der Bewältigung traumatisierender Erlebnisse unterstützen, damit diese möglichst keine PTBS entwickeln. Das Hauptziel unserer Studie ist mit einem 45-min Beratungsgespräch am Patientenbett, innerhalb von 48 Stunden nach dem Infarkt, die Entwicklung von posttraumatischen Stresssymptomen, die 3 Monate später gemessen werden, zu vermindern. Weitere Ziele sind die Verbesserung des Funktionsniveaus im Alltag, sowie der körperlichen und psychischen Gesundheit der Patienten, welche ein Beratungsgespräch nach notfallpsychologischen Vorgaben erhielten. Die Wirksamkeit der notfallpsychologischen Beratung wird verglichen mit derjenigen einer allgemeinen Intervention zur Stressreduktion. Wissenschaftlicher Kontext Sollte sich diese einfache Form eines notfallpsychologischen Beratungsgesprächs als wirksam erweisen, so könnte sie prinzipiell Eins-zu-Eins auf Herznotfallstationen umgesetzt werden, um die Lebensqualität und eventuell sogar die Prognose von Infarktpatienten zu verbessen.

Direct link to Lay Summary

Last update: 18.12.2013

Active participation

Communication	Title	Media	Place	Year

Title	Year

Number	Title	Start	Funding scheme

Background: Posttraumatic Stress Disorder (PTSD) is a mental disorder that may occur after someone experiences a traumatic event. PTSD is associated with impaired quality of life, social functioning, and high economic burden to the society. Between 10-20% of patients may develop PTSD in response to the traumatic experience of a myocardial infarction. Sociodemographic and psychosocial variables, including perceived distress during myocardial infarction (MI), have been identified as “risk factors” for the development of posttraumatic stress in the aftermath of MI. Posttraumatic stress attributable to MI has also been shown to be predictive of poor cardiovascular prognosis, whereby this link might relate to atherothrombotic processes like endothelial dysfunction, dyslipidemia, inflammation, and coagulation. Guidelines have been published for early interventions to prevent the development of posttraumatic stress after different types of trauma but not in terms of acute MI as a traumatic event. Main Aim: The overarching aim of the planned project is to test whether a minimal behavioral intervention performed shortly after acute MI in patients at a high risk to develop PTSD and in the setting of a coronary care unit (CCU) reduces the development of posttraumatic stress.Study Hypotheses: Our primary hypothesis is that posttraumatic stress levels at the 3-month follow-up (primary outcome) will be at least 20% lower in the intervention group than in the control group, and that this effect will last up to 12 months after the intervention. Our secondary hypothesis is that, at follow-up visits, the intervention group will show better psychosocial functioning, and a more favourable cardiometabolic biomarker profile (i.e. metabolic factors, biomarkers of endothelial dysfunction, inflammation and coagulation) (all secondary outcomes) than the control group.Study Design and Methods: The project will run for a period of 36 months (06/2012- 05/2015). We will enroll 426 patients between 18 and 80 years of age with a first-time MI at high risk to develop PTSD (i.e., those scoring on numeric rating scales (range 0-10) with at least 5 for chest pain plus at least 5 for fear of dying and/or helplessness/loss of control, all assessed at admission). Patients will be randomized to one single session of 45 min of either a behavioral intervention specifically targeting MI-triggered traumatic reactions (intervention group, n=213) or to receive general information about the role of psychological stress in coronary heart disease and how to deal with it (control group, n=213), both to be performed by the study therapist in the CCU within 48 h after patients have reached stable circulatory conditions. All patients will additionally receive written study material. The focus of the behavioral intervention is educational and resource-oriented targeting at individual resources and cognitive (re)structuring with regard to MI-related trauma stress. All patients will be assessed for previously identified “risk factors” of post-MI PTSD. Cardiac variables will be abstracted from hospital charts. Circulating levels of cardiometabolic biomarkers will also be determined. At the 3-month and 12-month follow-up all patients will be assessed for interviewer-rated posttraumatic stress levels, psychosocial functioning, and biomarkers. To identify adverse reactions, interim analyses will be performed after subgroups of 130 and 260 patients on “posttraumatic stress” at three months after the intervention. Expected Values: If effective, the planned project will be the first to show that the development of posttraumatic stress can successfully be prevented in post-MI patients at high risk to develop PTSD through a minimal behavioral intervention that is feasible (e.g. little-time consuming) to be administered in a busy CCU setting. A favorable cardiometabolic risk profile in the intervention group might inform a larger intervention trial to possibly improve cardiac prognosis in patients with PTSD attributable to MI, as biologically plausible atherothrombotic mechanisms would seem to be responsive to an early behavioral intervention.