Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia. / Barcella, Carlo Alberto; Mohr, Grimur; Kragholm, Kristian; Christensen, Daniel; Gerds, Thomas A.; Polcwiartek, Christoffer; Wissenberg, Mads; Bang, Casper; Folke, Fredrik; Torp-Pedersen, Christian; Kessing, Lars Vedel; Gislason, Gunnar Hilmar; Bach Sondergaard, Kathrine.
I: Heart, Bind 107, Nr. 19, 2021, s. 1544-1551.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia
AU - Barcella, Carlo Alberto
AU - Mohr, Grimur
AU - Kragholm, Kristian
AU - Christensen, Daniel
AU - Gerds, Thomas A.
AU - Polcwiartek, Christoffer
AU - Wissenberg, Mads
AU - Bang, Casper
AU - Folke, Fredrik
AU - Torp-Pedersen, Christian
AU - Kessing, Lars Vedel
AU - Gislason, Gunnar Hilmar
AU - Bach Sondergaard, Kathrine
PY - 2021
Y1 - 2021
N2 - Objective Patients with bipolar disorder and schizophrenia are at high cardiovascular risk; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared with the general population remains scarcely investigated. Methods We conducted a nested case-control study using Cox regression to assess the association of bipolar disorder and schizophrenia with the HRs of OHCA of presumed cardiac cause (2001-2015). Reported are the HRs with 95% CIs overall and in subgroups defined by established cardiac disease, cardiovascular risk factors and psychotropic drugs. Results We included 35 017 OHCA cases and 175 085 age-matched and sex-matched controls (median age 72 years and 66.9% male). Patients with bipolar disorder or schizophrenia had overall higher rates of OHCA compared with the general population: HR 2.74 (95% CI 2.41 to 3.13) and 4.49 (95% CI 4.00 to 5.10), respectively. The association persisted in patients with both cardiac disease and cardiovascular risk factors at baseline (bipolar disorder HR 2.14 (95% CI 1.72 to 2.66), schizophrenia 2.84 (95% CI 2.20 to 3.67)) and among patients without known risk factors (bipolar disorder HR 2.14 (95% CI 1.09 to 4.21), schizophrenia HR 5.16 (95% CI 3.17 to 8.39)). The results were confirmed in subanalyses only including OHCAs presenting with shockable rhythm or receiving an autopsy. Antipsychotics-but not antidepressants, lithium or antiepileptics (the last two only tested in bipolar disorder)-increased OHCA hazard compared with no use in both disorders. Conclusions Patients with bipolar disorder or schizophrenia have a higher rate of OHCA compared with the general population. Cardiac disease, cardiovascular risk factors and antipsychotics represent important underlying mechanisms.
AB - Objective Patients with bipolar disorder and schizophrenia are at high cardiovascular risk; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared with the general population remains scarcely investigated. Methods We conducted a nested case-control study using Cox regression to assess the association of bipolar disorder and schizophrenia with the HRs of OHCA of presumed cardiac cause (2001-2015). Reported are the HRs with 95% CIs overall and in subgroups defined by established cardiac disease, cardiovascular risk factors and psychotropic drugs. Results We included 35 017 OHCA cases and 175 085 age-matched and sex-matched controls (median age 72 years and 66.9% male). Patients with bipolar disorder or schizophrenia had overall higher rates of OHCA compared with the general population: HR 2.74 (95% CI 2.41 to 3.13) and 4.49 (95% CI 4.00 to 5.10), respectively. The association persisted in patients with both cardiac disease and cardiovascular risk factors at baseline (bipolar disorder HR 2.14 (95% CI 1.72 to 2.66), schizophrenia 2.84 (95% CI 2.20 to 3.67)) and among patients without known risk factors (bipolar disorder HR 2.14 (95% CI 1.09 to 4.21), schizophrenia HR 5.16 (95% CI 3.17 to 8.39)). The results were confirmed in subanalyses only including OHCAs presenting with shockable rhythm or receiving an autopsy. Antipsychotics-but not antidepressants, lithium or antiepileptics (the last two only tested in bipolar disorder)-increased OHCA hazard compared with no use in both disorders. Conclusions Patients with bipolar disorder or schizophrenia have a higher rate of OHCA compared with the general population. Cardiac disease, cardiovascular risk factors and antipsychotics represent important underlying mechanisms.
KW - ventricular arrhythmia ablation procedures
KW - cardiac arrest
KW - cardiac risk factors and prevention
KW - ventricular tachycardia
KW - epidemiology
KW - PHYSICAL ILLNESS
KW - MORTALITY
KW - DEATH
KW - MEDICATIONS
KW - NATIONWIDE
KW - REGISTER
KW - RATES
U2 - 10.1136/heartjnl-2020-318078
DO - 10.1136/heartjnl-2020-318078
M3 - Journal article
C2 - 33452118
VL - 107
SP - 1544
EP - 1551
JO - Heart
JF - Heart
SN - 1355-6037
IS - 19
ER -
ID: 281096247