NEW YORK (Reuters Health) – Symptoms of posttraumatic stress disorder (PTSD) appear to increase the long-term mortality rate in patients with implantable cardioverter defibrillators (ICDs), according to a report in the November issue of the Archives of General Psychiatry.

“To our knowledge, this is the first study to evaluate the effect of negative affectivity on the long-term mortality risk in patients with ICDs and is among the first follow-up studies in cardiac patient populations to apply PTSD symptoms as a risk predictor,” Dr. Karl-Heinz Ladwig and co-researchers point out.

The study findings indicate that during a mean follow-up period of 5.1 years, patients with PTSD symptoms were 3.45-times more likely to die than their peers without such symptoms, note Dr. Ladwig, from Technische Universitaet Muenchen in Germany, and colleagues (p = 0.002). Moreover, this association was independent of age, sex, diabetes, LV ejection fraction, beta-blocker use, ICD shocks received, depression and anxiety.

The team studied 147 patients who had received an ICD following a life-threatening cardiac event in 1998. During a 27-month post-implantation surveillance period, 38 of the patients were identified as having severe PTSD symptoms, while the remainder had only low or moderate symptoms.

Forty-five patients (30.6%) died during follow-up through March 2005, the report indicates. Of these patients, 32 had low or moderate PTSD symptoms and 13 had severe symptoms.

In terms of absolute mortality risk, the rate in patients with severe PTSD symptoms was 80 fatal events per 1000 person-years versus 50 fatal events per 1000 person-years in patients with only minimal or moderate symptoms.

The results provide direct evidence that PTSD symptoms are independently predictive of long-term mortality in patients who have received an ICD, the researchers conclude.

“Although the serious mortality risk of PTSD in patients with ICDs needs to be further investigated before firm recommendations can be made, screening for PTSD symptoms in patients with ICDs is likely to be clinically beneficial, and treatment in selected patients should be attempted,” the team states.

Reference:
Arch Gen Psychiatry 2008;65:1324-1330.