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Friday, November 28, 2008

PTSD and survival with ICDs

Archives of General Psychiatry has a paper suggesting PTSD is a strong marker of mortality in patients with internal cardioverter-defibrillators. The data come from a prospective German cohort study of ~150 patients with ICDs in which patients were screened for PTSD at baseline. The authors imply, but don't actually confirm in their study, that many/most of the patients with PTSD had it secondary to an acute cardiac event (such as a cardiac arrest or myocardial infarcation - part of the inclusion criteria for this study is that all patients had to have a rapid onset of their cardiac condition, ie a traumatic event, to qualify). 38 patients had severe PTSD symptoms at baseline, and had much worse outcomes (survival) even after controlling for multiple confounders including ejection fraction, age, number of ICD shocks, prior arrest, depression, anxiety, etc.: mortality was 55/1000 patient years for patients without PTSD and 88/1000 py for those with PTSD. (Overall mortality was 30% over an average of 5 years of follow-up.) It's a small study, and more hypothesis-generating than conclusive, but it's further suggestive evidence of just how significant psychiatric symptoms and morbidity can be for survival, particularly, perhaps, in cardiac diseases.

Thanks to Dr. Bob Arnold, again, for alerting me to this.

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