Posttraumatic Stress Disorder and Health-Related Quality of Life in Patients With Coronary Heart Disease Findings From the Heart and Soul Study (original) (raw)
Journal of Cardiology, 2011
OBJECTIVES: Posttraumatic stress disorder (PTSD) prospectively increases the risk of incident cardiovascular disease (CVD) independent of other risk factors in otherwise healthy individuals. Between 10% and 20% of patients develop PTSD related to the traumatic experience of myocardial infarction (MI). We investigated the hypothesis that PTSD symptoms caused by MI predict adverse cardiovascular outcome. METHODS: We studied 297 patients (61 ± 10 years, 83% men) who self-rated PTSD symptoms attributable to a previous index MI. Non-fatal CVD-related hospital readmissions (i.e. recurrent MI, elective and non-elective intracoronary stenting, bypass surgery, pacemaker implantation, cardiac arrhythmia, cerebrovascular event) were assessed at follow-up. Cox proportional hazard models controlled for demographic factors, coronary heart disease severity, major CVD risk factors, cardiac medication, and mental health treatment. RESULTS: Forty-three patients (14.5%) experienced an adverse event during a mean follow-up of 2.8 years (range 1.3-3.8). A 10 point higher level in the PTSD symptom score (mean 8.8 ± 9.0, range 0-47) revealed a hazard ratio (HR) of 1.42 (95% CI 1.07-1.88) for a CVD-related hospital readmission in the fully adjusted model. A similarly increased risk (HR 1.45, 95% CI 1.07-1.97) emerged for patients with a major or unscheduled CVD-related readmission (i.e. when excluding patients with elective stenting). CONCLUSIONS: Elevated levels of PTSD symptoms caused by MI may adversely impact non-fatal cardiovascular outcome in post-MI patients independent of other important prognostic factors. The possible importance of PTSD symptoms as a novel prognostic psychosocial risk factor in post-MI patients warrants further study.
Psychosomatic Medicine - PSYCHOSOM MED, 2005
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2021
Background The longitudinal association of posttraumatic stress disorder (PTSD) with health-related quality of life (HRQL) in cardiac patients’ remains poorly studied, particularly in conflict-affected settings. Materials and methods For this cohort study, we used baseline and one-year follow-up data collected from patients 30 to 80 years old consecutively admitted with a cardiac diagnosis to four major hospitals in Nablus, Palestine. All subjects were screened for PTSD and HRQL using the PTSD Checklist Specific and the HeartQoL questionnaire. We used a generalized structural equation model (GSEM) to examine the independent predictive association of PTSD at baseline with HRQL at follow-up. We also examined the mediating roles of depression, anxiety, and stress at baseline. Results The prevalence of moderate-to-high PTSD symptoms among 1022 patients at baseline was 27∙0%. Patients with PTSD symptoms reported an approximate 20∙0% lower HRQL at follow-up. The PTSD and HRQL relationship...
Cardiologia Croatica
SAŽetAK: Osim somatskih posljedica akutnoga koronarnog sindroma u obliku različitoga stupnja intolerancije napora, radne nesposobnosti, simptoma kroničnog srčanog zatajivanja, angine pektoris, pojave različitih aritmija i sl., moguć je već u ranoj subakutnoj te u kroničnoj fazi u oboljelih osoba razvoj niza psihosomatskih i psihičkih poremećaja, koji, ako se ne prepoznaju navrijeme i aktivno ne liječe, mogu pridonijeti nepovoljnom ishodu i povećanoj smrtnosti takve skupine bolesnika. Osim povezanosti akutnoga koronarnog sindroma i kroničnog stresa, anksioznosti i depresije, on može biti "okidač" za razvoj kasnijega posttraumatskoga stresnog poremećaja (PTSP) sa stopom prevalencije od prosječno 15-ak posto među oboljelim osobama. Više je istraživanja pokazalo da bolesnici sa simptomima PTSP-a povezanog s prethodnim akutnim koronarnim sindromom, napose oni neliječeni, imaju povećanu smrtnost i veću stopu reinfarkta miokarda. Budući da PTSP povezan s akutnim koronarnim sindromom ili kardiokirurškom operacijom zna biti zanemaren i podcijenjen, svrha je ovog rada podizanje svijesti o ovom problemu u svakodnevnoj kliničkoj praksi. SUMMARY: In addition to the somatic consequences of acute coronary syndrome (ACS) that include different levels of intolerance to exertion, incapacity for work, symptoms of chronic heart failure, angina pectoris, the manifestation of various arrhythmias, etc., the development of a whole range of psychosomatic and mental disorders is also possible already in the early subacute and chronic phases of the disease, and if these mental disorders are not actively treated in a timely fashion they can contributed to unwanted outcomes and increased mortality in this group of patients. ACS is associated with chronic stress, anxiety, and depression and can be a trigger for later development of posttraumatic stress disorder (PTSD) with an average prevalence rate of 15% in patients with ACS. Several studies have shown that patients with symptoms of PTSD associated with ACS, especially if untreated, have increased mortality and higher rates of myocardial reinfarction. Since PTSD associated with ACS or cardiac surgery can be neglected or underestimated, the aim of this review was to raise awareness about this issue that is present in everyday clinical practice.
Heart & Lung, 2008
OBJECTIVE: We estimated the prevalence of posttraumatic stress disorder (PTSD) and identified predictors of self-rated PTSD symptoms in patients post-myocardial infarction (MI). METHODS: We recruited 400 patients (mean age 60 +/-12 years, 79% were men) with a previous acute index MI who were referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale, and self-rated severity of PTSD symptom levels were assessed by the Posttraumatic Diagnostic Scale. RESULTS: Of the 190 patients who completed the Posttraumatic Diagnostic Scale, 34 met the cutoff for clinically significant PTSD symptomatology and 32 agreed to be interviewed. Among these patients, the Clinician-administered PTSD Scale interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% confidence interval 7.4-11.6). Retrospectively rated feelings of helplessness (beta = .47, P < .001) and pain intensity during MI (beta = .15, P = .019) independently predicted PTSD symptom level. CONCLUSIONS: Approximately 10% of patients post-MI had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level.
Psychosomatic medicine, 2018
Coronary Distensibility Index (CDI) impairments reflect endothelial-dependent process associated with vulnerable-plaque composition. This study investigated the relation of impaired CDI with posttraumatic stress disorder (PTSD) and their predictive value for major adverse cardiovascular events (MACE). This study involved 246 patients (age = 63 [10] years, 12% women) with (n = 50) and without (n = 196) PTSD, who underwent computed tomography angiography to determine coronary artery disease and CDI. Extent of coronary artery disease was defined as normal, nonobstructive (<50% luminal stenosis), and obstructive (>50%). Incidence of MACE, defined as myocardial infarction or cardiovascular death, was documented during a mean follow-up of 50 months. Survival regression was employed to assess the longitudinal association of impaired CDI and PTSD with MACE. A significant inverse correlation between CDI and Clinical Global Impression Severity scale of PTSD symptoms was noted (r = .81, ...
Posttraumatic stress disorder and risk for coronary heart disease: A meta-analytic review
American Heart Journal, 2013
The aim of this study was to estimate the association of posttraumatic stress disorder (PTSD) with risk for incident coronary heart disease (CHD). Design A systematic review and meta-analysis were used as study designs. Data Sources Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and PubMed Related Articles and through a manual search of reference lists (1948-present). Study Selection All studies that assessed PTSD in participants initially free of CHD and subsequently assessed CHD/ cardiac-specific mortality were included. Data Extraction Two investigators independently extracted estimates of the association of PTSD with CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HRs), and a random-effects model was used to pool results. A secondary analysis including only studies that reported estimates adjusted for depression was conducted. Results Six studies met our inclusion criteria (N = 402,274); 5 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.55 (95% CI 1.34-1.79) before adjustment for depression. The pooled HR estimate for the 5 depression-adjusted estimates (N = 362,950) was 1.27 (95% CI 1.08-1.49). Posttraumatic stress disorder is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates. It is common in both military veterans and civilian trauma survivors, and these results suggest that it may be a modifiable risk factor for CHD. Future research should identify the mechanisms of this association and determine whether PTSD treatment offsets CHD risk. (