New Study Finds Link Between Post Traumatic Stress Disorder and Increased Risk of Developing Atrial Fibrillation

Presented at Heart Rhythm 2018, first-of-its-kind, large scale study includes more than 1 million post-9/11 veterans receiving medical care

A new study is the first to report a relationship between post-traumatic stress disorder (PTSD) and new cases of atrial fibrillation (AF), the most common heart arrhythmia. The large nationwide study included more than 1 million patients with no prior history of AF or atrial flutter. The study is scheduled to be presented on Friday, May 11 at Heart Rhythm 2018, the Heart Rhythm Society’s 39^th Annual Scientific Sessions.  

AF affects more than 2.7 million American adults each year and this number is expected to increase to nearly eight million by the year 2050^[1]. Since AF significantly impacts both patients and the healthcare system, researchers are committed to identifying risks factors and developing novel strategies to prevent and manage the arrhythmia. Thus far, AF has been linked to traditional cardiovascular risk factors, including hypertension, diabetes, obesity and sleep apnea. Data linking psychological stress and negative emotions to AF are also beginning to emerge^[2]. PTSD is a related chronic stress condition that has been linked to other cardiovascular disease (e.g., hypertension), however, its relationship to AF has not been previously studied. 

This study included 1,063,973 post-9/11 veterans who first accessed medical care with the Veterans Health Administration (VHA) from October 2001 to November 2014 and had no history of AF or atrial flutter. Patients had a mean age of 30.29 ± 9.19 years at baseline and 87.8% were male. Multivariate Cox regression models were used to estimate the independent association of PTSD with incident AF after adjusting for demographic characteristics, lifestyle factors and time-dependent cardiovascular risk factors. 

During a mean follow up of almost five years (4.8 years), 2,491 veteran patients were diagnosed with AF. Results from this study show that a new diagnosis of PTSD was associated with an increased risk for AF diagnosis after adjustment for other variables such as age, gender, race, smoking status, body mass index, and diagnosis of hypertension, diabetes, coronary artery disease, myocardial infarction, drug and alcohol use/abuse disorders, major depressive disorder and obstructive sleep apnea. 

"These data suggest that PTSD is a potentially modifiable risk factor for AF," said Lindsey Rosman, PhD and Postdoctoral Research Fellow in Cardiovascular Medicine at the Yale School of Medicine. "Our results also raise the possibility that early detection and treatment of PTSD may reduce a patient’s risk for developing AF."

"It’s important to note that our patient population was much younger than the average patient diagnosed with AF and less than half had pre-existing structural cardiovascular disease prior to developing AF. These results point to a potential opportunity to prevent young people who are exposed to trauma from developing a dangerous heart arrhythmia like AF that greatly impacts their long-term health and quality of life," continued Dr. Rosman. 

The authors of this study call for further research to fully understand the behavioral and biological mechanisms underlying the relationship between PTSD and AF, as well as clinical trials to determine whether early treatment of PTSD can reduce AF risk. If these treatments are found to be effective, they could help manage the risk of an AF diagnosis caused by PTSD and potentially change patient outcomes. 

Sessions details:
"Featured Poster Session & Reception: Posttraumatic Stress Disorder And The Risk For Incident Atrial Fibrillation" [May 11, 2017 5:00 p.m. – 6:30 p.m. EDT, Poster Area, Exhibit Hall]

Heart Rhythm 2018 is the most comprehensive educational program for heart rhythm professionals, featuring more than 200 educational sessions and more than 140 exhibitors showcasing innovative products and services. The Heart Rhythm Society’s Annual Scientific Sessions have become the must-attend event of the year, allowing the exchange of new vital ideas and information among colleagues from every corner of the globe. For more information, visit www.hrssessions.org.

^[1] Cantillon, DJ. "Atrial Fibrillation." Atrial Fibrillation, Cleveland Clinic, Jan. 2014, www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/atrial-fibrillation/.

^[2] Eaker ED, Sullivan LM, Kelly-Hayes M, D'Agostino RB, Sr., Benjamin EJ. Anger and hostility predict the development of atrial fibrillation in men in the Framingham Offspring Study. Circulation. 2004;109(10):1267-1271.

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