# Testing a rapid outpatient management strategy on PTSD, cardiovascular and rehospitalization risk in TIA and minor stroke survivors evaluated in the Emergency Department

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2020 · $765,290

## Abstract

Recent research suggests that exposure to stressful aspects of emergency department (ED) and
inpatient care may increase risk for subsequent posttraumatic stress disorder (PTSD) and recurrent
cardiovascular events in patients who present to the ED with transient ischemic attacks and minor
strokes (TIAMS). There are currently no established clinical guidelines for emergency department
(ED) management of TIAMS after the initial evaluation and safety determination. This study will
compare psychological and long-term cardiovascular outcomes associated with the two most widely
employed strategies for managing TIAMS patients in US EDs.
We will use an observational design to compare TIAMS-induced PTSD symptoms, 30-day
rehospitalization, and 1-year cardiovascular disease (CVD)/mortality outcomes in TIAMS patients
managed according to (1) ED evaluation followed by inpatient admission strategy, versus (2) rapid
ED evaluation and discharge with a scheduled next-day outpatient neurology follow-up. Further,
we will assess autonomic nervous system (ANS) reactivity to the 2 strategies using ambulatory ECG.
This study design is possible because of a newly established Rapid Access Vascular Evaluation-
Neurology (RAVEN) TIAMS care pathway, which will be available for 2 weeks per month (on
alternating weeks) at Columbia University Medical Center. We hypothesize that patients treated
during RAVEN weeks will have lower PTSD symptoms, reduced 30d rehospitalization, and lower 1-
year CVD/mortality risk relative to those treated during the inpatient admission strategy weeks. We
will explore whether ANS markers of stress (ambulatory heart rate (HR) and heart rate variability
(HRV) in the 3 days after ED presentation) explain any group differences in study outcomes.
Nearly 1 in 5 TIA/MS survivors screen positive for PTSD in the month after the event, and research
in other CVD patients suggests that PTSD may increase risk for recurrent CVD events. To date,
research linking ED/inpatient exposure with subsequent PTSD has been unable to disentangle the
stress that results from the medical event itself from stress resulting from the hectic ED/inpatient
stay. If our hypothesis is correct -- that rapid ED discharge and outpatient follow-up reduces PTSD
symptoms and improves clinical outcomes in TIAMS survivors-- the results of our study will impact
clinical guidelines immediately. Furthermore, the study will have broader implications for the
clinical calculus of ED care versus outpatient follow-up for many other diseases, such as acute
coronary syndrome, traditionally managed with prolonged ED observation and inpatient care.

## Key facts

- **NIH application ID:** 9938616
- **Project number:** 5R01HL141811-03
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Bernard P. Chang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $765,290
- **Award type:** 5
- **Project period:** 2018-08-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9938616

## Citation

> US National Institutes of Health, RePORTER application 9938616, Testing a rapid outpatient management strategy on PTSD, cardiovascular and rehospitalization risk in TIA and minor stroke survivors evaluated in the Emergency Department (5R01HL141811-03). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9938616. Licensed CC0.

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