1. CoRPS Center of Research on Psychology in Somatic diseases Tilburg University The Netherlands Predictors of posttraumatic stress (PTSD) 18 months post ICD implantation Mirela Habibović, (MSc)

2. CoRPS Acknowledgements CoRPS – Tilburg University, the Netherlands -Krista C. van den Broek (PhD) -Johan Denollet (PhD) Amphia Hospital Breda, the Netherlands -Marco Alings (MD, PhD) -Eefje Postelmans -Hidde Weetink Catharina Hospital Eindhoven, the Netherlands - Pepijn H. van der Voort (MD)

3. CoRPS PTSD and mortality Ladwig et al., 2008 3-fold increased risk for mortality; p<.001

4. CoRPS Hypothesis Baseline (time of implantation) and 18-months Shocks  PTSD High baseline anxiety  PTSD Type D (distressed) personality  PTSD

5. CoRPS PDS (Posttraumatic Stress Diagnostic Scale) 17 items; 4-point scale Scores range 10 – 36; cut-off 20  moderate symptoms “Efforts to avoid thoughts, feelings, or conversations associated with the ICD” “Intens psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the ICD” “Efforts to avoid activities, places, or people that arouse recollections of the trauma”

6. CoRPS This study ICD implantation (with intense fear helplessness or horror) 1. Intrusive memories 2. Avoidance behavior 3. Hyperarousal (for at least 1 month post implantation) PTSD

7. CoRPS Baseline table Table 1: Baseline characteristics of the total sample as well as stratified by PTSD status* *Results are presented as numbers (%) unless otherwise indicated. ** Shocks received between implanation and 18-months. Total (N=395) PTSD (N=30) Non-PTSD (N=365) p. Age, mean±SD62.8±10.360.2±11.862.8±9.9.18 Gender (Female)75 (19.0)5 (16.7)70 (19.2).75 Partner (yes)338 (85.6)26 (86.7)312 (85.5).86 Indication (secondary)161 (41.2)16 (53.3)145 (40.2).16 CAD285 (72.2)24 (80.0)261 (71.5).32 Diabetes64 (16.4)2 (6.7)62 (17.2).14 Any shock**58 (15.1)7 (24.1)51 (14.4).16 Appropriate shocks40 (10.5)5 (17.2)35 (10).22 Inappropriate shocks18 (4.7)2 (6.9)16 (4.6).57 High baseline anxiety176 (45.6)25 (83.3)151 (42.4)<.001 Type D personality 85 (21.6)16 (55.2)69 (18.9) <.001 8% (N=30) qualified for PTSD diagnosis

8. CoRPS Univariate analyses

9. CoRPS Multivariable analyses - diagnosis Table 2: Independent predictor variables of PTSD diagnosis at 18-months following ICD implantation ss Predictor variableOR95%CIp Age0.970.93-1.01.14 Gender (Female)0.820.26-2.57.73 Partner (yes)0.660.17-2.49.54 Secondary indication1.380.60-3.21.45 CAD1.780.58-5.48.31 Diabetes0.330.07-1.52.16 Shocks2.080.71-6.06.18 High baseline anxiety4.291.46-12.57.008 Type D personality3.481.44-8.41.006

10. CoRPS Multivariable analyses - symptoms Shocks not related to increased posttraumatic symptom levels p=.58 High baseline anxiety associated with increased posttraumatic symptom levels p<.001 Type D personality associated with increased posttraumatic symptom levels p=.015

11. CoRPS Limitations Relatively small number of patients with PTSD Did not distinguish between appropriate and inappropriate shocks PTSD diagnosis set with self-administered questionnaire There was no comparison group

12. CoRPS Conclusions 8% (N=30) patients with PTSD at 18 months FU Shocks were associated with a 2-fold, non significant, increased risk for PTSD High baseline anxiety associated with a 4-fold increased risk for PTSD Type D personality associated with a 3- fold increased risk for PTSD

13. CoRPS Discussion PTSD predicts mortality in ICD patients Associated with impaired health status Associated with increased physiological stress responses Identifying a risk profile Screening for high risk patients? Kapa et al., 2010; Ladwig et al., 2008; Kubzansky et al., 2007