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Objective Hospital crowding is a public health problem that may impact on the quality of medical treatment and increase the risk of developing traumatic stress, e.g., after myocardial infarction (MI). This study examines whether subjective appraisal of crowding at hospital admission due to MI is associated with acute stress disorder (ASD) symptoms. Method We investigated 102 consecutive patients with acute MI within 48h after having reached stable circulatory conditions. The appraisal of crowding was measured by the retrospective assessment of the perception of a hectic hospital environment at admission. Furthermore, patients completed the Acute Stress Disorder Scale to rate the psychological stress reaction. Results The perception of a hectic hospital environment was associated with the development of ASD symptoms ( r =0.254, P =.013) independently of demographic, peritraumatic and medical factors. Post hoc analysis revealed associations with dissociative ( r =0.211, P =.041), reexperiencing ( r =0.184, P =.074) and arousal ( r =0.179, P =.083) symptoms. Conclusion The findings suggest that, besides objective circumstances, the way hospital admission due to MI is perceived by the patient may influence the development of MI-triggered ASD symptoms. The psychological and physiological long-term outcomes of the perception of a hectic hospital environment and the role of preventive interventions need further examination.

OBJECTIVES Myocardial infarction (MI) may be experienced as a traumatic event causing acute stress disorder (ASD). This mental disorder has an impact on the daily life of patients and is associated with the development of post-traumatic stress disorder. Trait resilience has been shown to be a protective factor for post-traumatic stress disorder, but its association with ASD in patients with MI is elusive and was examined in this study. METHODS We investigated 71 consecutive patients with acute MI within 48 h of having stable haemodynamic conditions established and for 3 months thereafter. All patients completed the Acute Stress Disorder Scale and the Resilience Scale to self-rate the severity of ASD symptoms and trait resilience, respectively. RESULTS Hierarchical regression analysis showed that greater resilience was associated with lower symptoms of ASD independent of covariates (b=-0.22, p

Background: Sleep problems predict incident cardiovascular events and mortality. Whether sleep also affects cardiovascular prognosis and through which mechanisms is less clear. We evaluated the relationship of a clinical risk of obstructive sleep apnea (OSA) and insomnia symptoms with neuroendocrine and coagulation activity in patients with acute myocardial infarction. Methods: Within 48 h of an acute coronary intervention, 190 patients (mean age 60 years, 82.6% male) were interviewed to assess OSA risk (STOP screening tool) and sleep difficulties (Jenkins Sleep Scale). Concentrations of epinephrine, norepinephrine, cortisol, fibrinogen, D-dimer, and von Willebrand factor were measured in plasma/serum. Multivariate models linking sleep to neuroendocrine and coagulation outcomes were controlled for demographic factors, health behaviors, comorbidity and cardiac-related variables, and mutually adjusted for OSA risk and sleep difficulties. Results: A high risk of OSA was identified in 40.5% of patients, and sleep difficulties on more than seven days in the previous four weeks were reported by 27.4% of patients. Compared to those with a low OSA risk, patients with a high OSA risk had lower epinephrine (p = 0.015), norepinephrine (p = 0.049) and cortisol (p = 0.001) levels, independently of covariates. More sleep difficulties were associated with higher fibrinogen (p = 0.037) and lower norepinephrine (p = 0.024) levels, with difficulties initiating, respectively maintaining sleep, driving these relationships. OSA risk was not significantly associated with coagulation activity. Conclusions: Sleep problems may relate to neuroendocrine and coagulation activity in patients with acute myocardial infarction. The pattern of relationships is not uniform for OSA and sleep difficulties and even varies between individual sleep difficulties.

Background Posttraumatic Stress Disorder (PTSD) may occur in patients after exposure to a life-threatening illness. About one out of six patients develop clinically relevant levels of PTSD symptoms after acute myocardial infarction (MI). Symptoms of PTSD are associated with impaired quality of life and increase the risk of recurrent cardiovascular events. The main hypothesis of the MI-SPRINT study is that trauma-focused psychological counseling is more effective than non-trauma focused counseling in preventing posttraumatic stress after acute MI. Methods/Design The study is a single-center, randomized controlled psychological trial with two active intervention arms. The sample consists of 426 patients aged 18 years or older who are at 'high risk’ to develop clinically relevant posttraumatic stress symptoms. 'High risk’ patients are identified with three single-item questions with a numeric rating scale (0 to 10) asking about 'pain during MI’, 'fear of dying until admission’ and/or 'worrying and feeling helpless when being told about having MI’. Exclusion criteria are emergency heart surgery, severe comorbidities, current severe depression, disorientation, cognitive impairment and suicidal ideation. Patients will be randomly allocated to a single 45-minute counseling session targeting either specific MI-triggered traumatic reactions (that is, the verum intervention) or the general role of psychosocial stress in coronary heart disease (that is, the control intervention). The session will take place in the coronary care unit within 48 hours, by the bedside, after patients have reached stable circulatory conditions. Each patient will additionally receive an illustrated information booklet as study material. Sociodemographic factors, psychosocial and medical data, and cardiometabolic risk factors will be assessed during hospitalization. The primary outcome is the interviewer-rated posttraumatic stress level at three-month follow-up, which is hypothesized to be at least 20% lower in the verum group than in the control group using the t-test. Secondary outcomes are posttraumatic stress levels at 12-month follow-up, and psychosocial functioning and cardiometabolic risk factors at both follow-up assessments. Discussion If the verum intervention proves to be effective, the study will be the first to show that a brief trauma-focused psychological intervention delivered within a somatic health care setting can reduce the incidence of posttraumatic stress in acute MI patients. Trial registration ClinicalTrials.gov: NCT01781247