Posttraumatic Stress Disorder and the Risk of Heart Failure Hospitalizations Among Individuals With Coronary Artery Disease.

IF 6.2 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation-Cardiovascular Quality and Outcomes Pub Date : 2024-11-20 DOI:10.1161/CIRCOUTCOMES.124.011040

Zakaria Almuwaqqat, Chang Liu, Yi-An Ko, Lisa Elon, Kasra Moazzami, Maggie Wang, Nancy Murrah, Lucy Shallenberger, Tené T Lewis, Amit J Shah, Paolo Raggi, J Douglas Bremner, Arshed A Quyyumi, Viola Vaccarino

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Abstract

Background: Posttraumatic stress disorder (PTSD) is associated with maladaptive dysregulation of stress response systems, which could lead to an increased risk of heart failure. We investigated whether PTSD was independently associated with first and recurrent heart failure hospitalizations in the setting of coronary artery disease.

Methods: Individuals with stable coronary artery disease and without heart failure at baseline were enrolled in 2 parallel prospective cohort studies in metropolitan Atlanta, GA. Participants underwent a structured clinical interview to assess their lifetime history of PTSD. Current PTSD symptoms were assessed using the PTSD symptom checklist. Participants were followed up for a median time of 4.9 years. The primary end point was first or recurrent hospitalization for heart failure. Secondary end points included cardiovascular death and nonfatal myocardial infarction with and without hospitalization for heart failure. Survival analysis for repeated events was used to assess the association of PTSD with adverse events.

Results: We studied 736 individuals with a mean age of 60±10 years; 36% were Black, and 35% were women. In total, 69 (9.4%) patients met the criteria for PTSD. Having a PTSD diagnosis was associated with the primary end point of first or recurrent heart failure hospitalizations, with a hazard ratio of 4.4 (95% CI, 2.6-7.3). The results were minimally attenuated after adjusting for demographic and clinical factors (hazard ratio, 3.7 [95% CI, 2.1-6.3]). Similarly, a 10-point increase in the PTSD symptom checklist score was associated with a 30% (95% CI, 10%-50%) increase in heart failure hospitalizations. PTSD was not associated with an end point of cardiovascular death or nonfatal myocardial infarction, which excluded hospitalizations due to heart failure.

Conclusions: Among patients with coronary artery disease, PTSD is associated with incident and recurrent heart failure hospitalizations. Future research is needed to investigate whether PTSD management can reduce the risk of heart failure.

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创伤后应激障碍与冠心病患者心力衰竭住院风险。

背景：创伤后应激障碍（PTSD创伤后应激障碍（PTSD）与应激反应系统的适应性失调有关，可能导致心力衰竭风险增加。我们研究了创伤后应激障碍是否与冠心病患者首次和复发心衰住院独立相关：美国佐治亚州亚特兰大市的两项平行前瞻性队列研究招募了基线时患有稳定冠状动脉疾病且无心力衰竭的患者。参与者接受了结构化临床访谈，以评估其一生中的创伤后应激障碍病史。目前的创伤后应激障碍症状则通过创伤后应激障碍症状清单进行评估。对参与者的随访时间中位数为 4.9 年。主要终点是首次或再次因心力衰竭住院。次要终点包括心血管死亡和非致命性心肌梗死，以及是否因心衰住院。重复事件的生存分析用于评估创伤后应激障碍与不良事件的关系：我们共研究了 736 人，平均年龄为 60±10 岁；其中 36% 为黑人，35% 为女性。共有 69 名（9.4%）患者符合创伤后应激障碍的标准。创伤后应激障碍诊断与首次或复发心衰住院这一主要终点相关，危险比为 4.4（95% CI，2.6-7.3）。在对人口统计学和临床因素进行调整后，这一结果略有减弱（危险比为 3.7 [95% CI，2.1-6.3]）。同样，创伤后应激障碍症状清单得分每增加 10 分，心衰住院率就会增加 30%（95% CI，10%-50%）。创伤后应激障碍与心血管死亡或非致死性心肌梗死的终点无关，这不包括因心衰而住院的情况：结论：在冠心病患者中，创伤后应激障碍与心力衰竭住院事件和复发有关。未来的研究需要探讨创伤后应激障碍的治疗能否降低心力衰竭的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation-Cardiovascular Quality and Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

8.50

自引率

2.90%

发文量

357

审稿时长

4-8 weeks

期刊介绍： Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.