Hamburg - A patient who receives an implantable cardiac
defibrillator (ICDs) after a heart attack is more than twice as
likely to die within five years from sheer anxiety over their heart
condition, according to a team of German scientists.
Even patients who display no severe heart problems after the ICD
is implanted have a higher risk of death owing to post-traumatic
stress disorder (PTSD) brought on by the trauma of having suffered a
heart attack, they said.
Cardiologists often overlook such fears. They tell their patients
they have nothing to fear but fear itself. But the patients remain
terrified that another heart attack could strike at any time - and
that fear increases the chances of another heart event.
The researchers from the Technische University of Munich in
Germany found that PTSD symptoms in this patient population were
associated with a 2.4-fold increased mortality risk.
'We were struck by the finding that patients suffering from PTSD
symptoms had a substantially higher risk of mortality, and it was
particularly striking that this association was strengthened after
adjustment for known risk factors. This study shows there is direct
evidence that PTSD independently influences mortality risk,' said
principal investigator Dr Karl-Heinz Ladwig.
The study was published in the November 2008 issue of Archives of
General Psychiatry.
According to Ladwig, PTSD is often overlooked in cardiac patients.
Although it is generally recognized that ICD patients should undergo
psychological screening and possible treatment as part of their
follow-up care, this does not always translate into clinical
practice.
'In part, this may have to do with the patients themselves, many
of whom are resistant to this type of care and are intent on coping
by themselves, but there is no doubt that they need help,' said
Ladwig.
The German researchers followed 211 patients with ICDs who
routinely attended a cardiac outpatient clinic after a cardiac event
in 1998. The study's primary outcome was mortality risk per 1,000
person-years.
Participants were surveyed an average of 27 months after
implantation, and at that time 38 reported severe PTSD symptoms and
109 reported low or moderate PTSD symptoms. During an average of 5.1
years, 45 (30.6 per cent) of the patients died: 32 of 109 patients
with low or moderate symptoms and 13 of 38 with high levels of
symptoms.
In their adjusted analyses, which controlled for age, sex,
diabetes mellitus, measures of cardiac disease, comorbid anxiety and
depression, the researchers found that PTSD symptoms substantially
increased mortality risk.
Despite assurances from cardiologists that they were doing fine,
some patients continued to have nagging doubts about their heart. And
those patients displayed higher risk of having another heart attack.
'Therefore, the perceived severity rather than the objective
severity of a cardiac condition, as determined by cardiac criteria,
may be associated with PTSD,' the authors write.
According to Ladwig, more research is needed to assess the
behavioural and biologic pathways by which PTSD contributes to excess
mortality risk in patients with ICDs.
USA
Your Talkback on this Story