Post-Traumatic Stress Disorder and Heart Failure in Men Within the Veteran Affairs Health System

Marat Fudim, Lukasz P. Cerbin, Srikant Devaraj, Tarek Ajam, Sunil V. Rao, Masoor Kamalesh

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Patients with post-traumatic stress disorder (PTSD) are at risk of multiple co-morbidities and are more likely to develop incident heart failure with reduced ejection fraction (HFrEF). The relation of PTSD with clinical outcomes in HFrEF is not established. US veterans diagnosed with HFrEF from January 2007 to January 2015 and treated nationwide in the Veterans Affairs (VA) Health System were included in the study. Patients with HFrEF were identified through International Classification of Diseases, Ninth Revision (ICD-9) codes. Mortality data were obtained from the VA's death registry. We compared characteristics of patients with HFrEF with and without PTSD. We identified 111,970 VA patients with HFrEF and 11,039 patients with concomitant PTSD (9.9%). Patients with PTSD and HFrEF tended to be younger (64 vs 69 years) and have a higher rate of coronary artery disease (73% vs 64%), chronic obstructive pulmonary disease (42% vs 31%), and hypertension (80% vs 64%, p <0.01 for all variables). Patients with PTSD and HFrEF were more commonly on a high-dose β blocker (70% vs 68%, p <0.01) and angiotensin-converting enzyme inhibitors (96% vs 93%, p <0.01). PTSD was associated with significantly increased mortality at 7 years compared with patients with heart failure without PTSD (adjusted 1.54, 95% confidence interval 1.30 to 1.82, p <0.01). In conclusion, nearly 10% of veterans with HFrEF have PTSD. Patients with HFrEF with PTSD have a higher burden of co-morbidities, and PTSD is associated with a higher rate of all-cause death. Our findings support greater attention to the treatment of patients with PTSD and the causes associated with the poor outcomes.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Veterans Health
Post-Traumatic Stress Disorders
Heart Failure
International Classification of Diseases
Veterans
Morbidity
Mortality
Angiotensin-Converting Enzyme Inhibitors
Chronic Obstructive Pulmonary Disease
Registries
Coronary Artery Disease
Cause of Death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Post-Traumatic Stress Disorder and Heart Failure in Men Within the Veteran Affairs Health System. / Fudim, Marat; Cerbin, Lukasz P.; Devaraj, Srikant; Ajam, Tarek; Rao, Sunil V.; Kamalesh, Masoor.

In: American Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Fudim, Marat ; Cerbin, Lukasz P. ; Devaraj, Srikant ; Ajam, Tarek ; Rao, Sunil V. ; Kamalesh, Masoor. / Post-Traumatic Stress Disorder and Heart Failure in Men Within the Veteran Affairs Health System. In: American Journal of Cardiology. 2018.
@article{1a3c168ecd214838b01151625c7af22d,
title = "Post-Traumatic Stress Disorder and Heart Failure in Men Within the Veteran Affairs Health System",
abstract = "Patients with post-traumatic stress disorder (PTSD) are at risk of multiple co-morbidities and are more likely to develop incident heart failure with reduced ejection fraction (HFrEF). The relation of PTSD with clinical outcomes in HFrEF is not established. US veterans diagnosed with HFrEF from January 2007 to January 2015 and treated nationwide in the Veterans Affairs (VA) Health System were included in the study. Patients with HFrEF were identified through International Classification of Diseases, Ninth Revision (ICD-9) codes. Mortality data were obtained from the VA's death registry. We compared characteristics of patients with HFrEF with and without PTSD. We identified 111,970 VA patients with HFrEF and 11,039 patients with concomitant PTSD (9.9{\%}). Patients with PTSD and HFrEF tended to be younger (64 vs 69 years) and have a higher rate of coronary artery disease (73{\%} vs 64{\%}), chronic obstructive pulmonary disease (42{\%} vs 31{\%}), and hypertension (80{\%} vs 64{\%}, p <0.01 for all variables). Patients with PTSD and HFrEF were more commonly on a high-dose β blocker (70{\%} vs 68{\%}, p <0.01) and angiotensin-converting enzyme inhibitors (96{\%} vs 93{\%}, p <0.01). PTSD was associated with significantly increased mortality at 7 years compared with patients with heart failure without PTSD (adjusted 1.54, 95{\%} confidence interval 1.30 to 1.82, p <0.01). In conclusion, nearly 10{\%} of veterans with HFrEF have PTSD. Patients with HFrEF with PTSD have a higher burden of co-morbidities, and PTSD is associated with a higher rate of all-cause death. Our findings support greater attention to the treatment of patients with PTSD and the causes associated with the poor outcomes.",
author = "Marat Fudim and Cerbin, {Lukasz P.} and Srikant Devaraj and Tarek Ajam and Rao, {Sunil V.} and Masoor Kamalesh",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.amjcard.2018.04.007",
language = "English (US)",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Post-Traumatic Stress Disorder and Heart Failure in Men Within the Veteran Affairs Health System

AU - Fudim, Marat

AU - Cerbin, Lukasz P.

AU - Devaraj, Srikant

AU - Ajam, Tarek

AU - Rao, Sunil V.

AU - Kamalesh, Masoor

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Patients with post-traumatic stress disorder (PTSD) are at risk of multiple co-morbidities and are more likely to develop incident heart failure with reduced ejection fraction (HFrEF). The relation of PTSD with clinical outcomes in HFrEF is not established. US veterans diagnosed with HFrEF from January 2007 to January 2015 and treated nationwide in the Veterans Affairs (VA) Health System were included in the study. Patients with HFrEF were identified through International Classification of Diseases, Ninth Revision (ICD-9) codes. Mortality data were obtained from the VA's death registry. We compared characteristics of patients with HFrEF with and without PTSD. We identified 111,970 VA patients with HFrEF and 11,039 patients with concomitant PTSD (9.9%). Patients with PTSD and HFrEF tended to be younger (64 vs 69 years) and have a higher rate of coronary artery disease (73% vs 64%), chronic obstructive pulmonary disease (42% vs 31%), and hypertension (80% vs 64%, p <0.01 for all variables). Patients with PTSD and HFrEF were more commonly on a high-dose β blocker (70% vs 68%, p <0.01) and angiotensin-converting enzyme inhibitors (96% vs 93%, p <0.01). PTSD was associated with significantly increased mortality at 7 years compared with patients with heart failure without PTSD (adjusted 1.54, 95% confidence interval 1.30 to 1.82, p <0.01). In conclusion, nearly 10% of veterans with HFrEF have PTSD. Patients with HFrEF with PTSD have a higher burden of co-morbidities, and PTSD is associated with a higher rate of all-cause death. Our findings support greater attention to the treatment of patients with PTSD and the causes associated with the poor outcomes.

AB - Patients with post-traumatic stress disorder (PTSD) are at risk of multiple co-morbidities and are more likely to develop incident heart failure with reduced ejection fraction (HFrEF). The relation of PTSD with clinical outcomes in HFrEF is not established. US veterans diagnosed with HFrEF from January 2007 to January 2015 and treated nationwide in the Veterans Affairs (VA) Health System were included in the study. Patients with HFrEF were identified through International Classification of Diseases, Ninth Revision (ICD-9) codes. Mortality data were obtained from the VA's death registry. We compared characteristics of patients with HFrEF with and without PTSD. We identified 111,970 VA patients with HFrEF and 11,039 patients with concomitant PTSD (9.9%). Patients with PTSD and HFrEF tended to be younger (64 vs 69 years) and have a higher rate of coronary artery disease (73% vs 64%), chronic obstructive pulmonary disease (42% vs 31%), and hypertension (80% vs 64%, p <0.01 for all variables). Patients with PTSD and HFrEF were more commonly on a high-dose β blocker (70% vs 68%, p <0.01) and angiotensin-converting enzyme inhibitors (96% vs 93%, p <0.01). PTSD was associated with significantly increased mortality at 7 years compared with patients with heart failure without PTSD (adjusted 1.54, 95% confidence interval 1.30 to 1.82, p <0.01). In conclusion, nearly 10% of veterans with HFrEF have PTSD. Patients with HFrEF with PTSD have a higher burden of co-morbidities, and PTSD is associated with a higher rate of all-cause death. Our findings support greater attention to the treatment of patients with PTSD and the causes associated with the poor outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85046752546&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046752546&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2018.04.007

DO - 10.1016/j.amjcard.2018.04.007

M3 - Article

C2 - 29731118

AN - SCOPUS:85046752546

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

ER -