Crowded emergency rooms linked to PTSD in heart patients

(Bloomberg) — Chaotic, overcrowded emergency rooms may cause some heart patients to develop post-traumatic stress disorder, a condition commonly associated with combat on the battlefield that can shorten life spans.

Patients suffering from chest pain who came to the emergency room of a New York City hospital during the busiest times were more likely to have symptoms of the disorder than those who showed up at quieter periods, according to a report released this week.

PTSD occurs in about 12% of heart attack patients and has been found to double their risk of dying over the next one to three years, says Donald Edmondson, a researcher on the study and assistant professor at Columbia University whose research focuses on the behavioral effects of disease. A hectic emergency room may intensify the emotional stress and fear of having chest pain causing patients to feel they are in greater danger, out of control and not being communicated to properly.

“A heart attack is in and of itself a life-threatening terrifying event, your body has turned against you, and you don’t know if you’re going to live through this thing,” Edmondson says. “An overcrowded ER can exacerbate that.”

The study tracked 135 patients who came to the emergency room at a New York City hospital with a condition called acute coronary syndrome. The researchers compared the traffic at the emergency room during the time they were there with whether the patients experienced symptoms of PTSD a month later. They found a direct correlation between the level of crowding at the ER and PTSD symptoms. On average, the patients spent nine to 11 hours at the ER, and the emergency room admitted 25% more patients during its busiest 24-hour periods, Edmondson said.

PTSD, which is best known for occurring in veterans of war or victims of an assault, is an anxiety disorder in which people experience flashbacks, nightmares and mood swings that disrupt their daily lives.

The finding adds to growing evidence that overwhelmed emergency departments can have greater consequences for patients than lengthy weight times, researchers say. Patients were more likely to die at the emergency room when it was overcrowded compared to during less busy times, according to a study published in December in the Annals of Emergency Medicine.

Emergency rooms across the United States may get even more crowded as the 30 million Americans expected to get health insurance under the 2010 Patient Protection and Affordable Care Act drive up demand for health services, Edmondson says.

“This is not just heart attack patients coming through the ER and being frightened, it is all of our patients,” he says. “The way we do this and decide to allow our ER to function may be impacting both the psychological quality of life and prognosis of our patients.”