Invasive Coronary Procedure Use and Outcomes Among Veterans with Posttraumatic Stress Disorder: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Details

• Personal Author:
  Bekelman DB ; Bradley SM ; Cohen BE ; Ho PM ; Hunt SC ; Maddox TM ; Matthieu MM ; Milek D ; Monteith LL ; Rumsfeld JS ; Schilling JH ; Shore S ; Stanislawski MA ; Varosy PD
• Description:
  Background: Posttraumatic stress disorder (PTSD) is prevalent in the general population and US veterans in particular and is associated with an increased risk of developing coronary artery disease (CAD). We compared the patient characteristics and postprocedural outcomes of veterans with and without PTSD undergoing coronary angiography. Methods: This is a multicenter observational study of patients who underwent coronary angiography in Veterans Affairs hospitals nationally from October 2007 to September 2011. We described patient characteristics at angiography, angiographic results, and after coronary angiography, we compared risk-adjusted 1-year rates of all-cause mortality, myocardial infarction (MI), and revascularization by the presence or absence of PTSD. Results: Overall, of 116,488 patients undergoing angiography, 14,918 (12.8%) had PTSD. Compared with those without PTSD, patients with PTSD were younger (median age 61.9 vs 63.7; P < .001), had higher rates of cardiovascular risk factors, and were more likely to have had a prior MI (26.4% vs 24.7%; P < .001). Patients with PTSD were more likely to present for stable angina (22.4% vs 17.0%) or atypical chest pain (58.5% vs 48.6%) and less likely to have obstructive CAD identified at angiography (55.9% vs 62.2%; P < .001). After coronary angiography, PTSD was associated with lower unadjusted 1-year rates of MI (hazard ratio (HR), 0.86; 95% CI [0.75-1.00]; P = 0.04), revascularization (HR, 0.88; 95% CI [0.83-0.93]; P < .001), and all-cause mortality (HR, 0.66; 95% CI [0.60-0.71]; P < .001). After adjustment for cardiovascular risk, PTSD was no longer associated with 1-year rates of MI or revascularization but remained associated with lower 1-year all-cause mortality (HR, 0.91; 95% CI [0.84-0.99]; P = .03). Findings were similar after further adjustment for depression, anxiety, alcohol or substance use disorders, and frequency of outpatient follow-up. Conclusions: Among veterans undergoing coronary angiography in the Veterans Affairs, those with PTSD were more likely to present with elective indications and less likely to have obstructive CAD. After coronary angiography, PTSD was not associated with adverse 1-year outcomes of MI, revascularization, or all-cause mortality. [Description provided by NIOSH]
• Subjects:
  Cardiovascular Diseases Cardiovascular System Mortality Occupational Health Safety
• Keywords:
  Cardiovascular Disease Heart Disease Military Personnel Mortality Rates Myocardial Disorders Post-traumatic Stress Disorder PTSD
• ISSN:
  0002-8703
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Colorado ; Missouri ; OSHA Region 10 ; OSHA Region 7 ; OSHA Region 8 ; OSHA Region 9 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  168
• Issue:
  3
• NIOSHTIC Number:
  nn:20055146
• Citation:
  Am Heart J 2014 Sep; 168(3):381-390.e6
• Contact Point Address:
  Steven M. Bradley, MD, MPH, VA Eastern Colorado Health Care System, Department of Veterans Affairs, 1055 Clermont St (111B), Denver, CO 80220-3808
• Email:
  Steven.Bradley@va.gov
• Federal Fiscal Year:
  2014
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  American Heart Journal
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:3a7c0bf45683e5471d6c33f173071b22fd68f193559a112f5849cf0c31bd8d23e6f0ad5fe5749319eb14ece2c77bbdb875fc0954f9343bd99cf840588cbc6859
• Download URL:
  https://stacks.cdc.gov/view/cdc/217508/cdc_217508_DS1.pdf
• File Type:
  [PDF - 406.75 KB ]