IMPACT OF POST-TRAUMATIC STRESS DISORDER (PTSD) ON PATIENTS WITH CORONARY ARTERY DISEASE (CAD): INSIGHTS FROM THE NATIONAL INPATIENT DATABASE 2021-2022

Abstract

Therapeutic Area

ASCVD/CVD in Special Populations

Background

While common modifiable factors for coronary artery disease (CAD) have been well studied, the data on impact of post-traumatic stress disorder (PTSD) on cardiovascular outcomes remains limited. Our study aims to assess the impact of PTSD on the mortality and secondary outcomes in CAD population.

Methods

Data was obtained from the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) 2021-2022 database using ICD-10-CM codes to assess the impact of PTSD on mortality and other variables including length of stay in hospital, cardiac arrest, and acute coronary syndrome, in CAD patients. Multivariable logistic regression analysis was applied to analyze the above outcomes.

Results

A total of 1,111,533 patients with CAD were identified in the NIS database, of which 12,107 patients had a diagnosis of PTSD. Patients in the PTSD cohort belonged to the 18-34 age group [OR = 22.57, (95% CI: 19.10, 26.68), p < 0.001], predominantly male [OR = 1.27, (95% CI: 1.22, 1.32), p <0.001], and Native Americans [OR = 6.01, (95% CI: 4.54, 7.96), p <0.001]. The presence of PTSD was associated with lower in-hospital mortality [OR = 0.46, (95% CI: 0.41, 0.53), p < 0.001], no change in length of stay [OR = 1.00, (95% CI: 1.00, 1.00), p = 0.995]. Moreover, secondary outcomes including cardiac arrest and acute coronary syndrome decreased odds (p < 0.001 and 0732, respectively) in patients with PTSD.

Conclusions

PTSD was associated with early onset CAD (as average age in the PTSD cohort was 18-34 years) compared to average onset of CAD at around 55 years in males. This may indicate increased risk of CAD in patients with PTSD, especially native Americans, however, other confounding social and lifestyle factors need to be studied. It was also interesting to find PTSD associated with CAD had decreased in hospital mortality compared to the control cohort. We do not feel that PTSD is protective in coronary artery disease, but rather the patient cohort with PTSD and CAD had smaller population and possibly increased healthcare utilization over a period of time. However, this will need to be further elucidated in future prospective clinical trials.