2285Increased risk of out-of-hospital cardiac arrest associated with psychiatric disorders

• Published in: European heart journal 2019-10, Vol.40 (Supplement_1)
• Main Authors: Barcella, C A, Mohr, G H, Kragholm, K, Christensen, D M, Polcwiartek, C, Wissenberg, M, Lippert, F K, Torp-Pedersen, C, Kessing, L V, Gislason, G H, Soendergaard, K B
• Format: Article
• Language: English
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz748.0130

Abstract Introduction Patients with psychiatric disorders are at high risk of cardiovascular morbidity and mortality; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared to the general population remains unknown. Purpose We investigated whether the presence and severity of different psychiatric disorders were associated with a higher risk of OHCA. Methods We conducted a case-control study matching all adult patients with OHCA of presumed cardiac cause between 2001 and 2014 with up to nine controls from the entire Danish population on age, sex and ischemic heart disease (IHD). Patients with psychiatric disorders were identified using in- and out-patient hospital diagnoses – both primary and secondary - before index date. We identified six mutually exclusive psychiatric disorders that were separately examined: personality disorders, anxiety, substance-related mental disorders, depression, bipolar disorder and schizophrenia. The risk of OHCA associated with the six psychiatric disorders was evaluated by conditional logistic regression adjusting for comorbidities, concomitant pharmacotherapy, socioeconomic status and marital status. Results We included 32,447 OHCA cases matched with 291,999 controls from the general population. Overall, the median age was 72 years, 67% were male and 29% had IHD prior to index date. All the six psychiatric disorders examined were more common among cases than controls; depression was the most common psychiatric disorders in both groups: 5.0% among cases and 2.8% among controls. Concurrently, all six psychiatric disorders were associated with significantly higher odds of OHCA: personality disorders (odds ratio (OR) 1.30 [95% confidence interval (CI) 1.06–1.60], anxiety OR 1.26 [95% CI 1.15–1.39], substance induced-mental disorders OR 2.36 [95% CI 2.17–2.57], depression OR 1.27 [95% CI 1.19–1.35], bipolar disorder OR 1.32 [95% CI 1.16–1.50] and schizophrenia OR 1.80 [95% CI 1.58–2.05] (Figure). The association persisted unaffected when we studied psychiatric patients neither exposed to antipsychotics nor to antidepressants. We observed a trend towards a stronger association when we stratified according to the severity of the psychiatric disorder (Figure). Severe disorders where classified as at least one hospitalization for the specific psychiatric illness as primary diagnosis during the five years prior to index date. Conclusions Common psychiatric disorders including personality disorders, anxiety, substance-related