Anxiety Disorders and Post-Traumatic Stress Disorder in Cardiovascular Disease: An Interactive Workshop

Abstract: Anxiety disorders and post-traumatic stress disorder (PTSD) are common in patients with heart disease, with 20-40% of individuals experiencing elevated levels of anxiety and 10-20% having symptoms consistent with an anxiety disorder or PTSD. While anxiety symptoms may pre-date a diagnosis of cardiovascular disease (CVD), they also may occur in response to a cardiac event (e.g., acute coronary syndrome) or treatment (e.g., firing of an implantable cardioverter-defibrillator) and may exacerbate cardiovascular symptoms (e.g., atrial fibrillation). Moreover, anxiety disorders and PTSD can contribute to adverse outcomes in CVD patients and occur comorbidly with depression, making depression management and recovery more complex. Knowledge of the diagnosis and management of these disorders in individuals with CVD is essential for CL psychiatrists, as they strive to provide the most appropriate, evidence-based care for patients with heart disease.

In this 90-minute workshop, we will provide a practical, interactive, evidence-informed update and discussion related to the diagnosis and management of anxiety disorders and PTSD in individuals with different types of CVD. Specific patient populations will include individuals with coronary artery disease, heart failure, atrial fibrillation, implantable cardioverter-defibrillator devices, aortic dissection, and those who with ventricular assist devices or who have undergone cardiac transplantation.

In the first 60 minutes of the workshop, several presenters will provide foundational information for the diagnosis and management of anxiety disorders and PTSD in specific cardiac populations (Dr. Celano: individuals with coronary artery disease or heart failure; Dr. Suarez: individuals with ventricular assist devices or following transplantation; Dr. Styra: individuals with atrial fibrillation; Dr. Funk: individuals with implantable cardioverter-defibrillators; Dr. Vartak: individuals with aortic dissection). For each of these topics, presenters will begin with a clinical case reflective of the population they are discussing. This will be followed by a review of the evidence for the diagnosis and treatment of anxiety and PTSD in that population, as well as best practice treatment approaches for the management of these symptoms. Participants will be asked to answer questions through electronic polls throughout this portion of the presentation, to increase engagement.

In the final 30 minutes, we will hold an interactive panel discussion that will focus on the incorporation of this information into clinical care. We will review the case vignettes presented in the first part of the program and will discuss the application of the topics presented to clinical practice. Audience members will be asked to provide feedback on how they would approach different clinical scenarios.

We hope that attendees will leave this workshop with an increased understanding of the epidemiology and diagnosis of PTSD and anxiety disorders in various cardiac populations, as well as evidence-based treatment approaches to psychiatric disorders in patients with heart disease.