PTSD more than doubles a veteran’s risk of death from any cause and is an independent risk factor for heart disease, according to VA researchers.¹

Researchers based out of the Greater Los Angeles VA studied the medical records of 286,194 veterans treated at VA medical centers in Southern California and Nevada.

Approximately 10.6% of those patients were diagnosed with PTSD. However, 28.9% of veterans in that group who died had PTSD. During an average follow-up of nearly 10 years, adjusting for age, gender and common cardiovascular risk factors, the study found that PTSD-diagnosed veterans had 2.41 times the rate of death from all causes, compared with veterans not having PTSD.

In a sub-study, researchers examined the amount of coronary artery calcium (CAC) in 637 veterans. They found that 76% of veterans with PTSD showed at least some CAC, compared with 59% of veterans without PTSD. The PTSD veterans had more severe disease of their arteries, with an average CAC score of 448, compared with a 332 score in veterans without PTSD.

At every level of calcium build-up, veterans with PTSD had a greater risk of death from any cause and a 41% greater risk of death due to cardiovascular disease than their counterparts who did not suffer from PTSD.

1.Ahmadi N, Hajsadeghi F, Mirshkarlo HB, Budoff M, Yehuda R, Ebrahimi R. Post-traumatic Stress Disorder, Coronary Atherosclerosis, and Mortality. Am J Cardiol. 2011 Apr 29. [Epub ahead of print].

Following Evidence-Based Guidelines Significantly Lowers Heart Failure Mortality

Adherence to national guideline-recommended therapies for heart failure significantly lowered the mortality rate of heart failure patients treated in an outpatient setting, according to a study by University of California, Los Angeles researchers. ¹

Published earlier this year, this is one of the first studies to examine how conformity with current and emerging heart-failure quality measures can affect patient survival and outcomes in the outpatient setting.

Researchers examined data on 15,177 heart failure patients seen at 167 cardiology practice clinics in the United States. The data was taken from a national quality improvement program called the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF). Researchers reviewed medical records at the beginning of the implementation of the IMPROVE program and followed up at 12 and 24 months to assess the relationship between adherence to seven nationally-recommended treatment measures and patient outcomes. 

Those measures included three types of heart failure medications (beta blockers, aldosterone antagonists and angiotensis-converting enzyme inhibitors or blockers), cardiac resynchronization therapy, anticoagulant therapy, the use of implantable cardio-defibrillators and heart-failure patient education.

At 24 months, 11,621 of the 15,177 patients (76.6%) had documented follow-up in the medical records. Patients represented a broad range of heart failure needs, with some qualifying for all seven measures and others only one or two. Researchers found that six out of the seven individual measures were associated with significantly improved patient survival over 24 months. The odds of mortality reduction ranged from 31% for anticoagulant therapy to 55% for beta-blocker use, compared with eligible patients who did not receive these therapies. In a summary score reflecting adherence to the quality measures, each 10 percent increase in the composite score was associated with 13% lower odds of 24-month mortality.

Patients who received all of the therapies for which they were eligible had 38% lower odds of mortality than patients who received none of the therapies.

Paul Heidenreich, MD, director of the Chronic Heart Failure Quality Enhancement Research Initiative at VA Palo Alto was one of the authors of the study. While the population examined was not from VA, previous work has proven that VA outperforms non-government hospitals in appropriate use of heart failure medications, particularly angiotensin converting enzyme inhibitors and beta-blockers.

“It is our opinion that a combination of performance measurements for network and facility administration, the electronic medical record with the ability to create reminders, and an overall culture of quality improvement among providers has helped VA achieve this level of care,” Heidenreich said.” 

1.Fonarow GC, Yancy CW, Hernandez AF, Peterson ED, Spertus JA, Heidenreich PA. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality. Am Heart J. 2011 Jun;161(6):1024-1030.e3.