Dyadic Health Consequences of Distress in Patients and their Partners After an Acute Cardiovascular Event

About This Grant

Every year, more than 1.6 million U.S. adults experience an acute cardiovascular disease (CVD) event (i.e., acute coronary syndrome, stroke/transient ischemic attack). Over 200,000 of these adults will develop clinically significant posttraumatic stress symptoms (PTSS) that undermine health behaviors (e.g., poor sleep, physical inactivity) and increase secondary risk. Critically, acute CVD is not experienced in isolation. Partners also experience significant distress, further endangering patients’ health—and their own. Aging partners are more likely to also be patients with chronic health conditions of their own, which underscores the necessity of examining acute CVD as a dyadic experience. The proposed study will be the first to empirically evaluate the impact of couples’ distress early after evaluation for acute CVD on dyadic health and estimate dyadic influences in the progression of patient and partner distress during the first month post-event. Relationships are among the strongest predictors of mental, physical, and behavioral health. Dyadic interventions could be leveraged to improve patient outcomes. Current recommendations to bring a close other to the ED as a source of support reflect our belief in the health-promoting potential of relationships. However, our research suggests that dyadic processes differ substantially early after an acute event v. during the well- studied chronic disease phase. In this early phase, partners can increase CVD patients’ psychological distress in the ED and, subsequently, worsen their PTSS. We will leverage our ED-based research infrastructure to recruit a diverse sample of patients evaluated for acute CVD and their partners (N = 160 dyads). Data collection will include surveys at baseline enrollment and 1- and 6-months post-hospital discharge, weekly assessments of distress during the first month post-discharge, and 28 days of continuous accelerometer- derived sleep and physical activity assessment. Guided by Cornelius’ (PI) dyadic disruption theory (DDT), we hypothesize that couples’ greater distress at ED evaluation will be associated with greater PTSS, poor sleep, and physical inactivity at 1- and 6-months post- hospital discharge. We expect to reveal dyadic influences in distress progression over the first month after acute CVD and will test theory-based mechanisms of patient and partner influence. We will use qualitative inquiry to elaborate, clarify, and enhance the validity of dyadic mechanisms of health and distress progression. We will query suggestions, preferences, and barriers regarding in-hospital dyadic interventions to address key gaps limiting clinical care, including the current lack of effective interventions to prevent medically induced PTSS and the unfortunately typical neglect of partners’ needs during the sensitive window early after acute CVD. Researchers and couples facing medical stressors report high enthusiasm for dyadic interventions. If successful, results will inform the generation of implementable, mechanistic interventions that can be delivered to couples in the hospital to promote dyadic mental, physical, and behavioral health and optimal aging.