Dyadic Health Consequences of Distress in Patients and their Partners After an Acute Cardiovascular Event
openNIA - National Institute on Aging
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.
Up to $3.3M
health research