Posttraumatic Distress Symptoms in Patients on Mechanical Circulatory Support

Introduction: Traumatization can lead to posttraumatic stress disorders (PTSD) and has been found to be especially prevalent in populations with serious medical illness, specifically of the heart. Major psychosocial outcome evaluation after serious end-stage heart failure rescued by mechanical circulatory support (MCS) implantation has not yet been assessed. This study aimed to determine symptoms of trauma and posttraumatic stress disease (PTSD) and ought to identify independent determinants of unfavorable progression of symptoms of trauma and PTSD.
Methods: A national, multi-center, cross-sectional study collected data from four heart-centers; this sample contained of 265 outpatients ongoing MCS support between three to 36 months (mean time 17±11 mts) post-implant. Patients mean age was 59±11yrs, 88% (N=234) were male, and 73% (N=193) lived with someone. Standardized PRO measures were applied; no missing at random was observed, missings on item level were outlined. Trauma and PTSD was assessed with the Breslau scale introduced by and open-ended question on “any traumatizing life events” and two follow-up questions. The study received IRB approval; registration no. NCT04526964.
Results: The weighted mean prevalence for patients reporting that they had experienced “any traumatizing event” (trauma) was 43.0% (95% CI 43.0-49.2); the weighted mean prevalence for a PTSD diagnosis was 3.8% (95% CI 1.82-6.83). Traumatizing events were categorized into non-heart-related versus heart-related events (both n=57; 50%); heart surgery (n=16) was most prominent. Oral intake of prescribed psychotropics (12.5%) was significantly higher in those with non-heart-related events (28.1% vs. 7.0%; p=0.006). Female gender was associated with an OR of 1.70 (95%CI: 1.22-2.38; p=0.002) for HADS_depression and oral psychotropics (OR 6.62, 95%CI: 2.01-21.83; p=0.002). HRQoL was lower for those on psychotropics (p=0.001). Patients who had experienced a trauma showed no differences in PTSS (p=0.771), anxiety (p=0.774), depression (p=0.565), and HRQoL (p=0.113).
Conclusion: A substantial proportion of MCS patients may have experienced traumatizing events; heart surgery was reported most prominently, may not just diminish the success of the implantation procedure, but may lead to posttraumatic stress disorders. Psychosocial outcome warrants routine clinical screening in patients following MCS implantation.