Adults with Chronic Heart Disease at Greater Risk for PTSD

Adults with chronic congenital heart disease (CHD) may be at greater risk for developing post-traumatic stress disorder (PTSD) compared to the general population, according to a new study by the Children’s Hospital of Philadelphia (CHOP).

Due to surgical and medical advances, there are now more American adults living with congenital heart defects than the annual number of children being born with them, even though heart defects are the most common birth defect in the U.S.

The findings show that about one in five adult patients in the study had PTSD symptoms, with about one in 10 patients having symptoms directly related to their heart condition. The researchers suggest that clinicians and caregivers be educated and aware of potential symptoms of PTSD, such as anxiety and depression, in their patients.

“Although the life expectancy of adults living with CHD has improved, ongoing care may include multiple surgeries and procedures,” said the study’s senior author, Yuli Kim, M.D., a cardiologist at CHOP.

“These patients remain at risk for both cardiac and non-cardiac effects of their chronic condition, and face unique life stressors that may place them at elevated risk for psychological stress.”

For the study, the researchers enrolled 134 patients with congenital heart defects, and questioned them regarding anxiety, depression, and PTSD using two validated mental health scales.

Of the 134 patients who completed one scale, 27 (21 percent) met criteria for PTSD symptoms. Of the 127 patients who completed another scale, 14 patients (11 percent) had PTSD symptoms specifically related to their CHD or treatment.

The prevalence of PTSD in this patient cohort (11 to 21 percent) is several times higher than the 3.5 percent rate found in the general population. The researchers say that the prevalence is comparable to that found in children with CHD and in adults with acquired heart disease.

The two factors most strongly associated with PTSD were elevated symptoms of depression and when the patient last had cardiac surgery. Surprisingly, patients who had undergone cardiac surgery further back in time were more likely to have PTSD. This finding may reflect recent medical and surgical advances that lessen traumatic impacts, or alternatively, a “residual stress” explanation — that traumatic stress leads to chronic, long-term symptoms.

The researchers also note that non-medical traumatic events may have contributed to PTSD in some patients. Furthermore, said the authors, the self-report measurements used in the research may not be as accurate as a clinical interview.

Overall, the findings may reveal important unmet needs in a growing population of patients.

“The high prevalence of PTSD detected in these adult CHD patients has important clinical implications,” said corresponding author Lisa X. Deng of CHOP’s Division of Cardiology.

She noted that less than half of the study patients presenting with PTSD symptoms were being treated for PTSD, and added that, “We need to conduct more research to identify measures along the lifespan to support our patients and ensure that they have a good quality of life.”

The study is published in the American Journal of Cardiology.

Source: Children’s Hospital of Philadelphia
Doctor listening to patient’s heart photo by shutterstock.