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January 04, 2016

CHOP study finds link between heart disease and PTSD

Study looked at 134 adult patients with congenital heart disease, found 27 with PTSD

Researchers at the Children's Hospital of Philadelphia have found a strong correlation between heart disease and post-traumatic stress disorder, with around one in five patients in the study showing symptoms of PTSD.

The study focused on congenital heart disease, a chronic condition that patients must live with from the day they are born. Dr. Yuli Kim and her colleagues began their investigation after seeing the fears and worries of their patients first-hand. 

"As congenital heart specialists, we noticed that there was a lot of anxiety in our patients and we weren't sure if this anxiety had anything to do with their heart condition," said Kim, director of the Adult Congenital Heart Disease Center.

Her patients dread going to the doctor and hearing "bad news" - the announcement that they need another surgery or that their condition has gotten worse. While many patients are well-adjusted, for some the anxiety can be "disabling." 

Doctors recruited 134 adult patients with congenital heart disease and gave them questionnaires that test for signs of PTSD, anxiety and depression. Twenty-seven of those people, or 21 percent, showed likely symptoms of PTSD - but out of that group, only 11 people were getting treatment, and only one person had a clinical diagnosis of the disorder on their medical chart.

The results were surprising, but the implications are clear, said Dr. Kim: "Doctors in general should be asking our patients with chronic anxiety about how it affects their lives."  

In comparison, 3.5 percent of the general population shows signs of PTSD. Previous studies found very high rates of PTSD in pediatric heart disease (29 percent) and acquired heart disease (38 percent), but this is the first study done on PTSD and congenital heart disease in adults. 

Another questionnaire, completed by 127 patients, pinpointed whether PTSD symptoms were linked to a specific traumatic event. 11 percent of that group had symptoms related directly to  their heart disease, less than the number of people who showed signs of PTSD generally. 

"It's certainly possible that we're picking up other causes of PTSD from other sources of trauma," said Kim. 

The range of woes that patients had gone through included heart attacks, strokes, invasive surgeries, car accidents and cancer. Out of the total group, 38 patients were attending therapy or taking psychological medications. 

Contradicting the saying that "time heals all," patients were more likely to show PTSD symptoms if more time had passed since their most recent surgery. One hopeful explanation for this is that advances in anesthesia and patient care may have made modern surgeries less traumatic; a more troubling theory is that painful memories can actually deepen over time into a chronic disorder.

Researchers acknowledged the study's limitations: the sample size was small and no one was officially diagnosed with PTSD. For future studies, Dr. Kim would be eager to work with a psychologist for in-depth mental evaluations. She would also want to closely examine how long the disorder endures and whether it affects health outcomes. 

"There are serious implications in terms of hospitalizations and poor outcomes," she said. 

The study, published in the December issue of the American Journal of Cardiology, is available here (behind a paywall). A free summary is available on Medscape here

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