Prognostic Impacts and Temporal Changes of Post-Traumatic Stress Disorder after the Great East Japan Earthquake in Patients with Heart Failure - A Report from the CHART-2 Study

BackgroundIn March 2011, the Great East Japan Earthquake, followed by the devastating tsunami and the Fukushima-Daiichi nuclear power plant explosion, caused severe damage in the Tohoku District of Japan. It is well known that the great disasters cause post-traumatic stress disorder (PTSD) in the general population. However, long-term prognostic impacts and temporal changes of PTSD in patients with heart failure (HF) remain to be examined.MethodsWe examined the prevalence and the prognostic impacts of PTSD after the Great East Japan Earthquake in HF patients registered in our CHART (Chronic Heart Failure Analysis and Registry in the Tohoku District)-2 Study (N=10,219). We sent a self-administered questionnaire with the Japanese version of the Impact of Event Scale-Revised (IES-R-J) every October between 2011 and 2013. PTSD was defined as a score of ≥25 in IES-R-J.ResultsIn the 3,620 valid responses obtained in 2011, 534 patients (14.7%) were found to have PTSD. The prevalence of PTSD was highest in the area suffered by the Tsunami or within close proximity (<30 km) to the Fukushima Daiichi Nuclear Power Plants (36.3%), and was decreased along with decrement in earthquake intensity. Importantly, during the median follow-up of 2 years, the patients with PTSD, as compared with those without it, more frequently experienced cardiovascular endpoints consisting of all-cause death and hospitalization for acute myocardial infarction, angina pectoris, stroke and HF admission (18.3% vs. 14.1%, adjusted hazard ratio 1.26; 95% CI 1.02-1.57, P=0.035) (Table 1). The PTSD prevalence was 14.7, 15.7 and 7.4% in 2011, 2012 and 2013, respectively, indicating a peak prevalence in 2012 (P<0.01).ConclusionsTable 1Cox Regression Models for All-Cause Death and Cardiovascular EndpointsHazard Ratio95% CIP valuePTSD (IES-R-J>25)1.261.02-1.570.035Age at questionnaire1.031.01-1.03<0.001Male sex1.271.04-1.570.02HF in Stage C/D1.301.20-1.560.02History of hospitalization for HF1.291.07-1.390.03LVEF<50%1.481.32-1.76<0.001BMI0.970.95-0.990.002Systolic blood pressure1.011.01-1.02<0.001Cancer1.351.06-1.720.02Atrial fibrillation1.321.09-1.600.004eGFR0.990.98-0.99<0.001BNP (per 100pg/mL)1.031.01-1.050.005ACE-I or ARB0.770.65-0.940.007Abbreviations: ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction. Open table in a new tab BackgroundIn March 2011, the Great East Japan Earthquake, followed by the devastating tsunami and the Fukushima-Daiichi nuclear power plant explosion, caused severe damage in the Tohoku District of Japan. It is well known that the great disasters cause post-traumatic stress disorder (PTSD) in the general population. However, long-term prognostic impacts and temporal changes of PTSD in patients with heart failure (HF) remain to be examined. In March 2011, the Great East Japan Earthquake, followed by the devastating tsunami and the Fukushima-Daiichi nuclear power plant explosion, caused severe damage in the Tohoku District of Japan. It is well known that the great disasters cause post-traumatic stress disorder (PTSD) in the general population. However, long-term prognostic impacts and temporal changes of PTSD in patients with heart failure (HF) remain to be examined. MethodsWe examined the prevalence and the prognostic impacts of PTSD after the Great East Japan Earthquake in HF patients registered in our CHART (Chronic Heart Failure Analysis and Registry in the Tohoku District)-2 Study (N=10,219). We sent a self-administered questionnaire with the Japanese version of the Impact of Event Scale-Revised (IES-R-J) every October between 2011 and 2013. PTSD was defined as a score of ≥25 in IES-R-J. We examined the prevalence and the prognostic impacts of PTSD after the Great East Japan Earthquake in HF patients registered in our CHART (Chronic Heart Failure Analysis and Registry in the Tohoku District)-2 Study (N=10,219). We sent a self-administered questionnaire with the Japanese version of the Impact of Event Scale-Revised (IES-R-J) every October between 2011 and 2013. PTSD was defined as a score of ≥25 in IES-R-J. ResultsIn the 3,620 valid responses obtained in 2011, 534 patients (14.7%) were found to have PTSD. The prevalence of PTSD was highest in the area suffered by the Tsunami or within close proximity (<30 km) to the Fukushima Daiichi Nuclear Power Plants (36.3%), and was decreased along with decrement in earthquake intensity. Importantly, during the median follow-up of 2 years, the patients with PTSD, as compared with those without it, more frequently experienced cardiovascular endpoints consisting of all-cause death and hospitalization for acute myocardial infarction, angina pectoris, stroke and HF admission (18.3% vs. 14.1%, adjusted hazard ratio 1.26; 95% CI 1.02-1.57, P=0.035) (Table 1). The PTSD prevalence was 14.7, 15.7 and 7.4% in 2011, 2012 and 2013, respectively, indicating a peak prevalence in 2012 (P<0.01). In the 3,620 valid responses obtained in 2011, 534 patients (14.7%) were found to have PTSD. The prevalence of PTSD was highest in the area suffered by the Tsunami or within close proximity (<30 km) to the Fukushima Daiichi Nuclear Power Plants (36.3%), and was decreased along with decrement in earthquake intensity. Importantly, during the median follow-up of 2 years, the patients with PTSD, as compared with those without it, more frequently experienced cardiovascular endpoints consisting of all-cause death and hospitalization for acute myocardial infarction, angina pectoris, stroke and HF admission (18.3% vs. 14.1%, adjusted hazard ratio 1.26; 95% CI 1.02-1.57, P=0.035) (Table 1). The PTSD prevalence was 14.7, 15.7 and 7.4% in 2011, 2012 and 2013, respectively, indicating a peak prevalence in 2012 (P<0.01). ConclusionsTable 1Cox Regression Models for All-Cause Death and Cardiovascular EndpointsHazard Ratio95% CIP valuePTSD (IES-R-J>25)1.261.02-1.570.035Age at questionnaire1.031.01-1.03<0.001Male sex1.271.04-1.570.02HF in Stage C/D1.301.20-1.560.02History of hospitalization for HF1.291.07-1.390.03LVEF<50%1.481.32-1.76<0.001BMI0.970.95-0.990.002Systolic blood pressure1.011.01-1.02<0.001Cancer1.351.06-1.720.02Atrial fibrillation1.321.09-1.600.004eGFR0.990.98-0.99<0.001BNP (per 100pg/mL)1.031.01-1.050.005ACE-I or ARB0.770.65-0.940.007Abbreviations: ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction. Open table in a new tab Abbreviations: ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction.