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Fernandes A, Manivannan A, Schou M, Fosbøl E, Køber L, Gustafsson F, Gislason GH, Torp-Pedersen C, Andersson C. Clinical Trajectories and Long-Term Outcomes of Alcoholic Versus Other Forms of Dilated Cardiomyopathy. Heart Lung Circ 2024; 33:368-375. [PMID: 38336540 DOI: 10.1016/j.hlc.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/22/2023] [Accepted: 11/21/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Alcoholic cardiomyopathy (ACM) is a form of dilated cardiomyopathy (DCM) occurring secondary to long-standing heavy alcohol use and is associated with poor outcomes, but the cause-specific risks are insufficiently understood. METHOD Between 1997 and 2018, we identified all patients with a first diagnosis of ACM or DCM. The cumulative incidence of different causes of hospitalisation and mortality in the two groups was calculated using the Fine-Gray and Kaplan-Meier methods. RESULTS A Total of 1,237 patients with ACM (mean age 56.3±10.1 years, 89% men) and 17,211 individuals with DCM (mean age 63.6±13.8 years, 71% men) were identified. Diabetes (10% vs 15%), hypertension (22% vs 31%), and stroke (8% vs 10%) were less common in ACM than DCM, whereas obstructive lung disease (15% vs 12%) and liver disease (17% vs 2%) were more prevalent (p<0.05). Cumulative 5-year mortality was 49% in ACM vs 33% in DCM, p<0.0001, multivariable adjusted hazards ratio 2.11 (95% confidence interval 1.97-2.26). The distribution of causes of death was similar in ACM and DCM, with the predominance of cardiovascular causes in both groups (42% in ACM vs 44% in DCM). 5-year cumulative incidence of heart failure hospitalisations (48% vs 54%) and any somatic cause (59% vs 65%) were also similar in ACM vs DCM. At 1 year, the use of beta blockers (55% vs 80%) and implantable cardioverter defibrillators (3% vs 14%) were significantly less often used in ACM vs DCM. CONCLUSIONS Patients with ACM had similar cardiovascular risks and hospitalisation patterns as other forms of DCM, but lower use of guideline-directed cardiovascular therapies and greater mortality.
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Affiliation(s)
- Amanda Fernandes
- Department of Medicine, Section of Cardiovascular Medicine, Boston University Medical Center, Boston, MA, USA.
| | - Alan Manivannan
- Department of Medicine, Section of Internal Medicine, Boston University Medical Center, Boston, MA, USA
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
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Høgnason Mohr G, Barcella CA, Grand MK, Kriegbaum M, Siersma V, Hahn MK, Agarwal SM, Bakkedal C, Baandrup L, Knop FK, Andersen CL, Ebdrup BH. Management of dyslipidaemia in individuals with severe mental illness: a population-based study in the Greater Copenhagen Area. Ther Adv Psychopharmacol 2023; 13:20451253231211574. [PMID: 38022836 PMCID: PMC10656803 DOI: 10.1177/20451253231211574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Severe mental illness (SMI) is associated with increased cardiovascular risk. Dyslipidaemia is a potentially modifiable risk factor, which may be inadequately managed in patients with SMI. Objectives To assess management of dyslipidaemia in patients with SMI versus healthy controls (HCs) in 2005 and 2015. Design and methods Using Danish registers, we identified adult patients with SMI in the Greater Copenhagen Area (schizophrenia spectrum disorders or bipolar disorder) with ⩾1 general practitioner contact in the year before 2005 and 2015, respectively, and HCs without SMI matched on age and gender (1:5). Outcomes were lipid-profile measurements, presence of dyslipidaemia and redemption of lipid-lowering pharmacotherapy. Differences in outcomes between patients with SMI and controls were measured with multivariable logistic regression. Results We identified 7217 patients with SMI in 2005 and 9939 in 2015. After 10 years, patients went from having lower odds of lipid measurements to having higher odds of lipid measurements compared with HCs [odds ratio (OR)2005 0.70 (99% confidence interval (CI) 0.63-0.78) versus OR2015 1.34 (99% CI 1.24-1.44); p2005versus2015 < 0.01]. Patients had higher odds of dyslipidaemia during both years [OR2005 1.43 (99% CI 1.10-1.85) and OR2015 1.23 (99% CI 1.08-1.41)]. Patients went from having lower odds of receiving lipid-lowering pharmacotherapy to having higher odds of receiving lipid-lowering pharmacotherapy [OR2005 0.77 (99% CI 0.66-0.89) versus OR2015 1.37 (99% CI 1.24-1.51); p2005versus2015 < 0.01]. However, among persons at high cardiovascular risk, patients had lower odds of receiving lipid-lowering pharmacotherapy during both years, including subsets with previous acute coronary syndrome [OR2005 0.30 (99% CI 0.15-0.59) and OR2015 0.44 (99% CI 0.24-0.83)] and ischaemic stroke or transient ischaemic attack (TIA) [OR2005 0.43 (99% CI 0.26-0.69) and OR 2015 0.61 (99% CI 0.41-0.89)]. Conclusion These results imply an increased general awareness of managing dyslipidaemia among patients with SMI in the primary prophylaxis of cardiovascular disease. However, secondary prevention with lipid-lowering drugs in patients with SMI at high cardiovascular risk may be lacking.
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Affiliation(s)
- Grimur Høgnason Mohr
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, 2600 Glostrup, Denmark
| | - Carlo Alberto Barcella
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, University of Copenhagen, Hellerup, Denmark
- Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margaret K. Hahn
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Catrine Bakkedal
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Baandrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Mental Health Centre Copenhagen, Bispebjerg-Gentofte, Copenhagen NV, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip Krag Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Christen Lykkegaard Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bjørn Hylsebeck Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Barcella CA, Christensen DM, Idorn L, Mudalige N, Malmborg M, Folke F, Torp-Pedersen C, Gislason G, El-Chouli M. Outcomes of out-of-hospital cardiac arrest in adult congenital heart disease: a Danish nationwide study. Eur Heart J 2023; 44:3264-3274. [PMID: 37409410 DOI: 10.1093/eurheartj/ehad358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/20/2023] [Accepted: 04/18/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS The risk, characteristics, and outcome of out-of-hospital cardiac arrest (OHCA) in patients with congenital heart disease (CHD) remain scarcely investigated. METHODS AND RESULTS An epidemiological registry-based study was conducted. Using time-dependent Cox regression models fitted with a nested case-control design, hazard ratios (HRs) with 95% confidence intervals of OHCA of presumed cardiac cause (2001-19) associated with simple, moderate, and severe CHD were calculated. Moreover, using multiple logistic regression, we investigated the association between pre-hospital OHCA characteristics and 30-day survival and compared 30-day survival in OHCA patients with and without CHD. Overall, 43 967 cases (105 with simple, 144 with moderate, and 53 with severe CHD) and 219 772 controls (median age 72 years, 68.2% male) were identified. Any type of CHD was found to be associated with higher rates of OHCA compared with the background population [simple CHD: HR 1.37 (1.08-1.70); moderate CHD: HR 1.64 (1.36-1.99); and severe CHD: HR 4.36 (3.01-6.30)]. Pre-hospital cardiopulmonary resuscitation and defibrillation were both associated with improved 30-day survival in patients with CHD, regardless of CHD severity. Among patients with OHCA, simple, moderate, and severe CHD had a similar likelihood of 30-day survival compared with no CHD [odds ratio 0.95 (0.53-1.69), 0.70 (0.43-1.14), and 0.68 (0.33-1.57), respectively]. CONCLUSION A higher risk of OHCA was found throughout the spectrum of CHD. Patients with and without CHD showed the same 30-day survival, which relies on the pre-hospital chain of survival, namely cardiopulmonary resuscitation and defibrillation.
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Affiliation(s)
- Carlo Alberto Barcella
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Internal Medicine, Nykøbing Falster Hospital, Fjordvej 15, 4800 Nykøbing Falster, Denmark
| | | | - Lars Idorn
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Nishan Mudalige
- Health Systems Intelligence Unit, Data Analytics, Reporting and Evaluation, Provincial Health Services Authority, British Columbia, Canada
| | - Morten Malmborg
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Frederik Folke
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
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Eroglu TE, Coronel R, Halili A, Kessing LV, Arulmurugananthavadivel A, Parveen S, Folke F, Torp-Pedersen C, Gislason GH. Long-term stress conditions and out-of-hospital cardiac arrest risk: a nested case-control study. Open Heart 2023; 10:openhrt-2022-002223. [PMID: 37147025 PMCID: PMC10163588 DOI: 10.1136/openhrt-2022-002223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/11/2023] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE Patients with stress-related disorders and anxiety are at increased risk of developing cardiovascular disease. However, the risk of out-of-hospital cardiac arrest (OHCA) is scarcely investigated. We aimed to establish whether long-term stress (post-traumatic stress disorder, adjustment disorder) or anxiety is associated with OHCA in the general population. METHODS We conducted a nested case-control study in a nationwide cohort of individuals between 1 June 2001 and 31 December 2015 in Denmark. Cases were OHCA patients with presumed cardiac causes. Each case was matched by age, sex and date of OHCA with 10 non-OHCA controls from the general population. HRs for OHCA were derived from Cox models after controlling for common OHCA risk factors. Stratified analyses were performed according to sex, age and pre-existing cardiovascular disease. RESULTS We included 35 195 OHCAs and 351 950 matched controls (median age 72 years; 66.8% male). Long-term stress conditions were diagnosed in 324 (0.92%) OHCA cases and 1577 (0.45%) non-OHCA controls, and were associated with higher rate of OHCA (HR 1.44, 95% CI 1.27 to 1.64). Anxiety was diagnosed in 299 (0.85%) OHCA cases and 1298 (0.37%) controls, and was associated with increased rate of OHCA (HR 1.56, 95% CI1.37 to 1.79). We found no interaction with sex, age or history of cardiovascular diseases. CONCLUSION Patients with stress-related disorders or anxiety have an increased rate of OHCA. This association applies equally to men and women and is independent from the presence of cardiovascular disease. Awareness of the higher risks of OHCA in patients with stress-related disorders and anxiety is important when treating these patients.
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Affiliation(s)
- Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ruben Coronel
- Heart Failure Research Center, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Andrim Halili
- Department of Cardiology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Cardiology, Bispebjerg Hospital, Kobenhavn, Denmark
| | | | | | - Saaima Parveen
- Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark
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Alm-Kruse K, Tjelmeland I, Reiner A, Kvåle R, Kramer-Johansen J. Use of healthcare services before and after out-of-hospital cardiac arrest. Resuscitation 2023; 187:109805. [PMID: 37088268 DOI: 10.1016/j.resuscitation.2023.109805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Knowledge about the use of healthcare services in patients experiencing out-of-hospital cardiac arrest (OHCA) is limited. We aimed to describe and compare the use of healthcare by OHCA survivors two years before and one year after cardiac arrest. METHODS Adult patients with OHCA of medical cause, who survived >30 days, were identified in the Norwegian Cardiac Arrest Registry. The Norwegian Patient Registry, The Cause of Death Registry, and The Norwegian Registry for Primary Healthcare provided data on survival and the use of healthcare services. We investigated the use of primary, specialist and mental healthcare, as well as rehabilitation services. RESULTS In 2015-2018, 13,112 OHCA cases were identified; 1435 (14%) patients survived >30 days (6.8/100,000 patients/year). The proportion of patients in the cohort that used primary healthcare each month increased form 43% before to 69% after OHCAto (p<0.001). We found a doubling of monthly healthcare contacts in both specialist healthcare (from 26% to 57%, p<0.001) and mental healthcare (from 3% to 8%, p>0.001). The observed increases in primary, specialist and mental healthcare use started two weeks, six months, and eight months before OHCA, respectively. Half of the patients had contact with primary healthcare services on the same day as the cardiac arrest. Two out of five patients were registered for rehabilitation after OHCA. CONCLUSION The use of primary, specialist and mental healthcare services increased before OHCA and remained significantly higher the year after OHCA. Less than half of the patients surviving cardiac arrest were registered for rehabilitation.
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Affiliation(s)
- Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
| | - Andrew Reiner
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Rune Kvåle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; Department of Health Registry Research and Development, National Institute of Public Health, Bergen, Norway
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
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Zylyftari N, Lee CJY, Gnesin F, Møller AL, Mills EHA, Møller SG, Jensen B, Ringgren KB, Kragholm K, Christensen HC, Blomberg SNF, Tan HL, Folke F, Køber L, Gislason G, Torp-Pedersen C. Registered prodromal symptoms of out-of-hospital cardiac arrest among patients calling the medical helpline services. Int J Cardiol 2023; 374:42-50. [PMID: 36496039 DOI: 10.1016/j.ijcard.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/12/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Background Early identification of warning symptoms among out-of-hospital cardiac arrest (OHCA) patients remains challenging. Thus, we examined the registered prodromal symptoms of patients who called medical helpline services within 30-days before OHCA. Methods Patients unwitnessed by emergency medical services (EMS) aged ≥18 years during their OHCA were identified from the Danish Cardiac Arrest Registry (2014-2018) and linked to phone records from the 24-h emergency helpline (1-1-2) and out-of-hours medical helpline (1813-Medical Helpline) in Copenhagen before the arrest. The registered symptoms were categorized into chest pain; breathing problems; central nervous system (CNS)-related/unconsciousness; abdominal/back/urinary; psychiatric/addiction; infection/fever; trauma/exposure; and unspecified (diverse from the beforementioned categories). Analyses were divided by the time-period of calls (0-7 days/8-30 days preceding OHCA) and call type (1-1-2/1813-Medical Helpline). Results Of all OHCA patients, 18% (974/5442) called helpline services (males 56%, median age 76 years[Q1-Q3:65-84]). Among these, 816 had 1145 calls with registered symptoms. The most common symptom categories (except for unspecified, 33%) were breathing problems (17%), trauma/exposure (17%), CNS/unconsciousness (15%), abdominal/back/urinary (12%), and chest pain (9%). Most patients (61%) called 1813-Medical Helpline, especially for abdominal/back/urinary (17%). Patients calling 1-1-2 had breathing problems (24%) and CNS/unconsciousness (23%). Nearly half of the patients called within 7 days before their OHCA, and CNS/unconsciousness (19%) was the most registered. The unspecified category remained the most common during both time periods (32%;33%) and call type (24%;39%). Conclusions Among patients who called medical helplines services up to 30-days before their OHCA, besides symptoms being highly varied (unspecified (33%)), breathing problems (17%) were the most registered symptom-specific category.
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Affiliation(s)
- Nertila Zylyftari
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark.
| | - Christina Ji-Young Lee
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Elisabeth Helen Anna Mills
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sidsel G Møller
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Denmark; Copenhagen Emergency Medical Services, Denmark
| | - Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Denmark
| | - Kristian Bundgaard Ringgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Anesthesia and Intensive Care, North Denmark Regional Hospital, Denmark
| | - Kristian Kragholm
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center AMC, University of Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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Edwards GG, Uy-Evanado A, Stecker EC, Salvucci A, Jui J, Chugh SS, Reinier K. Sudden cardiac arrest in patients with schizophrenia: A population-based study of resuscitation outcomes and pre-existing cardiovascular disease. IJC HEART & VASCULATURE 2022; 40:101027. [PMID: 35434255 PMCID: PMC9006855 DOI: 10.1016/j.ijcha.2022.101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 01/18/2023]
Abstract
Objective Individuals with schizophrenia carry a high burden of cardiovascular disease and elevated rates of sudden cardiac arrest (SCA), but little published data is available regarding survival from SCA in this population. The authors compared cardiovascular disease burden and resuscitation outcomes following SCA in individuals with and without schizophrenia. Methods Case-control analysis drawn from a prospective community-based study of SCA in a large community. The authors defined cases as having a pre-SCA history of schizophrenia, and controls as individuals with SCA without a history of schizophrenia. SCA cases with schizophrenia were compared to a 1:5 age- and sex-frequency-matched sample of SCA cases without schizophrenia. Results The 103 SCA schizophrenia cases were as likely as the 515 cases without schizophrenia to have resuscitation attempted (75% vs. 80%; p = 0.24) and had a shorter 911 call mean response time (5.8 min vs. 6.9 min, p < 0.001). However, they were significantly less likely to present with a shockable rhythm (ventricular fibrillation/pulseless ventricular tachycardia 16% vs. 43%, p < 0.001), and less likely to survive to hospital discharge (3% vs. 14%, p = 0.008). Pre-arrest cardiovascular disease burden was similar in patients with and without schizophrenia. Conclusions Despite comparable resuscitation characteristics and cardiovascular disease burden, patients with schizophrenia had significantly lower rates of SCA survival. The paucity of previous research into this phenomenon warrants further investigation to identify factors that may improve survival.
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Affiliation(s)
- Gabriel G. Edwards
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States,Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Eric C. Stecker
- Oregon Health and Science University, Portland, OR, United States
| | - Angelo Salvucci
- Ventura County Health Care Agency, Ventura, CA, United States
| | - Jonathan Jui
- Oregon Health and Science University, Portland, OR, United States
| | - Sumeet S. Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States,Corresponding author at: Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, United States.
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Alotaibi R, Halbesma N, Bijman LA, Clegg G, Smith DJ, Jackson CA. Incidence, characteristics and outcomes of out-of-hospital cardiac arrests in patients with psychiatric illness: A systematic review. Resusc Plus 2022; 9:100214. [PMID: 35243451 PMCID: PMC8861157 DOI: 10.1016/j.resplu.2022.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 11/08/2022] Open
Abstract
Aim To conduct a systematic literature review of the existing evidence on incidence, characteristics and outcomes after out-of-hospital cardiac arrest (OHCA) in patients with psychiatric illness. Methods We searched Embase, Medline, PsycINFO and Web of Science using a comprehensive electronic search strategy to identify observational studies reporting on OHCA incidence, characteristics or outcomes by psychiatric illness status. One reviewer screened all titles and abstracts, and a second reviewer screened a random 10%. Two reviewers independently performed data extraction and quality assessment. Results Our search retrieved 11,380 studies, 10 of which met our inclusion criteria (8 retrospective cohort studies and two nested case-control studies). Three studies focused on depression, whilst seven included various psychiatric conditions. Among patients with an OHCA, those with psychiatric illness (compared to those without) were more likely to have: an arrest in a private location; an unwitnessed arrest; more comorbidities; less bystander cardiopulmonary resuscitation; and an initial non-shockable rhythm. Two studies reported on OHCA incidence proportion and two reported on survival, showing higher risk, but lower survival, in patients with psychiatric illness. Conclusion Psychiatric illness in relation to OHCA incidence and outcomes has rarely been studied and only a handful of studies have reported on OHCA characteristics, highlighting the need for further research in this area. The scant existing literature suggests that psychiatric illness may be associated with higher risks of OHCA, unfavourable characteristics and poorer survival. Future studies should further investigate these links and the role of potential contributory factors such as socioeconomic status and comorbidities.
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Mackenhauer J, Valentin JB, Mikkelsen S, Steinmetz J, Væggemose U, Christensen HC, Mainz J, Johnsen SP, Christensen EF. Emergency Medical Services response levels and subsequent emergency contacts among patients with a history of mental illness in Denmark: a nationwide study. Eur J Emerg Med 2021; 28:363-372. [PMID: 33709996 DOI: 10.1097/mej.0000000000000806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE People with mental illness have higher use of emergency services than the general population and may experience problems with navigating in complex healthcare systems. Poor physical health contributes to the excess mortality among the mentally ill. OBJECTIVE To compare the level of Emergency Medical Services (EMS) response and subsequent contacts emergency between patients with and without a history of mental illness. DESIGN, SETTING, AND PARTICIPANTS A nationwide cohort study was conducted in Denmark including medical 1-1-2 calls 2016 2017. The healthcare system is financed through taxation allowing free access to healthcare services including ambulance services. EXPOSURE Exposed groups had a history of major, moderate, or minor mental illness. OUTCOME MEASURES AND ANALYSIS We studied seven national prehospital care Performance Indicators (PI 1-7). The selected PI concerned EMS response levels and subsequent contacts to prehospital and in-hospital services. Exposed groups were compared to nonexposed groups using regression analyses. RESULTS We included 492 388 medical 1-1-2 calls: 8, 10, and 18% of calls concerned patients with a history of major, moderate, or minor mental illness, respectively.There were no clinically relevant differences regarding response times (PI 1-2) or registration of symptoms (PI 3) between groups.If only telephone advice was offered, patients with a history of major, moderate or minor mental illness were more likely to recall within 24 h (PI 4): adjusted risk ratio (RR) 2.11 (1.88-2.40), 1.96 (1.20-2.21), and 1.38 (1.20-1.60), but less or equally likely to have an unplanned hospital contact within 7 days (PI 6): adjusted RRs 1.05 (0.99-1.12), 1.04 (0.99-1.10), and 0.90 (0.85-0.94), respectively.If released at the scene, the risk of recalling (PI 5) or having an unplanned hospital contact (PI 7) was higher among patients with a history of mental illness: adjusted RRs 2.86 (2.44-3.36), 2.41 (2.05-2.83), and 1.57 (1.35-1.84), and adjusted RRs 2.10 (1.94-2.28), 1.68 (1.55-1.81), and 1.25 (1.17-1.33), respectively.Patients with a history of mental illness were more likely to receive telephone advice only adjusted RRs 1.61 (1.53-1.70), 1.30 (1.24-1.37), and 1.08 (1.04-1.13), and being released at scene adjusted RRs 1.11 (1.08-1.13), 1.03 (1.01-1.04), and 1.05 (1.03-1.07). CONCLUSION More than one-third of the study population had a history of mental illness. These patients received a significantly lighter EMS response than patients with no history of mental illness. They were significantly more likely to use the emergency care system again if released at scene. This risk increased with the increasing severity of the mental illness.
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Affiliation(s)
- Julie Mackenhauer
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University
- Psychiatry, Aalborg University Hospital, Mølleparkvej 10, North Denmark Region, Aalborg
| | - Jan Brink Valentin
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, University of Southern Denmark Odense
| | | | - Ulla Væggemose
- Research and Development, Prehospital Emergency Medical Services, Central Denmark Region
- Department of Clinical Medicine, Aarhus University
| | | | - Jan Mainz
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University
- Psychiatry, Aalborg University Hospital, Mølleparkvej 10, North Denmark Region, Aalborg
- Department for Community Mental Health, Haifa University, Haifa, Israel
- Department of Health Economics, University of Southern Denmark, Odense
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Mølleparkvej 10, Aalborg University
| | - Erika Frischknecht Christensen
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University
- Centre for Prehospital and Emergency Research, Internal and Emergency Medicine Clinic, Aalborg University Hospital, Aalborg
- Prehospital Emergency Medical Services, North Denmark Region, Denmark
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Barcella CA, Mohr G, Kragholm K, Christensen D, Gerds TA, Polcwiartek C, Wissenberg M, Bang C, Folke F, Torp-Pedersen C, Kessing LV, Gislason GH, Bach Søndergaard K. Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia. Heart 2021; 107:1544-1551. [PMID: 33452118 DOI: 10.1136/heartjnl-2020-318078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Carlo Alberto Barcella
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
| | - Grimur Mohr
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Daniel Christensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Thomas A Gerds
- The Danish Heart Foundation, Copenhagen, Denmark.,Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
| | - Casper Bang
- Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerod, Denmark.,Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerod, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
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11
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Desai R, Amraotkar AR, Toft LB. Impact of age, gender, race, and ethnicity on mortality in out-of-hospital cardiac arrest with psychiatric disorder in the United States. Resuscitation 2020; 146:80-81. [DOI: 10.1016/j.resuscitation.2019.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
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12
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Masterson S, Gräsner JT. Stronger together — The power of combining existing registry data. Resuscitation 2019; 143:219-220. [DOI: 10.1016/j.resuscitation.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
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