For nearly 15 years, Donald Edmondson, PhD, executive director of the Center for Behavioral Cardiovascular Health at Columbia University Irving Medical Center in New York City, has worked to shed light on the fact that up to one third of individuals who experience major, life-changing cardiac events go on to develop a posttraumatic stress disorder called cardiac PTSD.
Edmondson has been the lead investigator on or participated on research teams behind more than 50 clinical studies showing everything from which patients are most likely to develop this unique form of medical trauma to how cardiologists can predict which of their patients may be most likely to experience its burdens.
James Jackson, PsyD, who is the director of behavioral health at Vanderbilt University in Nashville, Tennessee, and helped start the ICU Recovery Center at Vanderbilt in 2013, was among the first clinicians to address cardiac PTSD in a focused manner. He said their team realized that there were specific efforts to help survivors of cancer, for example, but no programs to help other populations, including survivors of the cardiovascular ICU.
“We tailor our care and try to individualize it, but there is always a strong psychological component, with a particular focus on mental health and neuropsychological challenges,” said Jackson, who has worked with Edmondson on several studies. “Addressing these as early as we can is crucial because in the absence of early intervention, these problems threaten to morph into challenges that are even harder to handle.”
All this work has reached the point where the clinicians and researchers are ready to begin developing the interventions that may one day help patients exit the cycle of cardiac PTSD or avoid it altogether. Tens of millions of people affected by cardiac PTSD each year may be able to treat their potentially deadly cardiovascular disease without being traumatized by it at the same time.
Hands-On Interventions Could Start As Simply As 1, 2, 3, 4
Research showed that it would be possible to potentially start these interventions with something as simple as a 4-point screening system for cardiologists to add to their patient follow-ups, Edmondson said.
“The first thing they should be looking for is if the cardiac event really scared the patient. Perhaps they [say they were] terrified about it,” Edmondson said, in talking about what such an assessment might look like. “Secondly, patients who talk about their cardiac sensations, their chest sensations, are more at risk. They talk a lot about their symptoms and perhaps are asking ‘Hey, I’ve been feeling this. What does that mean?’”
A third indicator is if they talk about sleep problems. And if they say they’re not being physically active, “those are the types of things that together can give you a pretty good indication as to being at higher risk,” Edmondson said.
Edmondson said that upon assessing risk in a patient, the cardiologist would probably refer that patient over to a behavioral health professional for further treatment. At that point, he said that exposure therapy was just one of several types of therapies that would be researched for efficacy, depending on the patient’s most serious symptoms.
“The existing model for depression care in cardiology is a good place to start in terms of researching collaborative treatment for cardiac PTSD,” Edmondson said. “We were getting some good preliminary data on this that we could significantly reduce secondary cardiac risk and mortality risk and improve health behaviors by bringing behavioral medicine [and] behavioral health into the cardiology clinic for recent cardiac event survivors.”
Another thing Edmondson pointed out is that many of the patients who later go on to develop cardiac PTSD are extremely frightened from the moment they interact with the medical process, either with emergency medical technicians or in the emergency department. A 2019 study published by Jeena Moss, MD, an emergency medicine physician at Mount Sinai Hospital in Queens, New York, established that clinician compassion and generally making the medical experience less stressful helped to interrupt the cycle of the disease — but that’s extremely difficult to standardize.
A 2018 study Edmondson published with an extensive team showed preliminary evidence of a placebo-like effect of percutaneous intervention (PCI) and stent placement.
“We think this is because many patients who receive PCI incorrectly believe they are ‘cured,’” Edmondson said. “This is the ‘plumbing’ model of ACS, where they believe a blockage is opened up and all is good now.”
Is there a way to use that information to help those who suffer from cardiac PTSD — not by erroneously installing a stent, but by redirecting the power of the human mind?
How Tech Can Help
Significant technology-based interventions are also in the early stages of development. Jeffrey L. Birk, PhD, MS, an assistant professor in the Department of Medicine at Columbia University in New York City, developed a study that would investigate modifying patients’ fear of their cardiac event recurring, fear that in the case of cardiac PTSD came in the form of intrusive thoughts. Birk said he focused on the internal nature of the triggers that caused these threatening reminders, such as increases in heart rate and perceived arrhythmias, which he noted could also be triggered by engaging in healthy physical activity.
“We want to be able to assess for whom and how often this maladaptive avoidance of physical activity is actually occurring during recovery after patients go home from the hospital,” Birk said.
While he noted that systems already exist to prompt patients to self-report on the frequency of intrusive thoughts, these devices can’t assess for context, and that’s where he wants to go next.
“One important future direction of this research is to develop ways of investigating these processes dynamically over time as they unfold in real time during patients’ lives,” he said. “We need to understand how and when interoceptive attention is problematic for patients’ mental and physical well-being.”
Sachin Agarwal, MD, MPH, an assistant professor of neurology at Columbia University and a critical care neurologist at NewYork-Presbyterian, believes technology can help continue the path forward.
“We’re beginning to explore how AI-powered survivorship models can deliver personalized support, improve follow-up engagement, and extend the reach of family-centered interventions beyond the hospital walls,” Agarwal said. “Whether through intelligent triage, conversational agents, or digital peer support networks, these tools have the potential to translate our original vision into something both sustainable and system-wide.”
