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

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C A Barcella ◽  
G H Mohr ◽  
K Kragholm ◽  
D M Christensen ◽  
C Polcwiartek ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cardiac Arrest ◽  
High Risk ◽  
General Population ◽  
Mental Disorders ◽  
Personality Disorders ◽  
Psychiatric Disorders ◽  
Index Date ◽  
Psychiatric Patients ◽  
Hospital Cardiac Arrest

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 mental disorders, depression, bipolar disorder and schizophrenia are significantly associated with higher odds of OHCA. These findings provide a rationale for early cardiovascular risk factor screening and, potentially, management among psychiatric patients to identify patients at high risk of OHCA. Acknowledgement/Funding ESCAPE-NET project

Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318078
Author(s):  
Carlo Alberto Barcella ◽  
Grimur Mohr ◽  
Kristian Kragholm ◽  
Daniel Christensen ◽  
Thomas A Gerds ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Cardiac Arrest ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Cardiac Disease ◽  
Cox Regression ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

ObjectivePatients 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.MethodsWe 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.ResultsWe 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.ConclusionsPatients 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.

scholarly journals Contacts to the healthcare system prior to out-of-hospital cardiac arrests

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Zylyftari ◽  
S.G Moller ◽  
M Wissenberg ◽  
F Folke ◽  
C.A Barcella ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
General Population ◽  
Healthcare System ◽  
Early Identification ◽  
Sudden Cardiac Arrest ◽  
Funding Source ◽  
Horizon 2020 ◽  
One Year ◽  
Public Grant ◽  
Hospital Cardiac Arrest

Abstract Background Patients who suffer a sudden out-of-hospital cardiac arrest (OHCA) may be preceded by warning symptoms and healthcare system contact. Though, is currently difficult early identification of sudden cardiac arrest patients. Purpose We aimed to examine contacts with the healthcare system up to two weeks and one year before OHCA. Methods OHCA patients were identified from the Danish Cardiac Arrest Registry (2001–2014). The pattern of healthcare contacts (with either general practitioner (GP) or hospital) within the year prior to OHCA of OHCA patients was compared with that of 9 sex- and age-matched controls from the background general population. Additionally, we evaluated characteristics of OHCA patients according to the type of healthcare contact (GP/hospital/both/no-contact) and the including characteristics of contacts, within two weeks prior their OHCA event. Results Out of 28,955 OHCA patients (median age of 72 (62–81) years and with 67% male) of presumed cardiac cause, 16,735 (57.8%) contacted the healthcare system (GP and hospital) within two weeks prior to OHCA. From one year before OHCA, the weekly percentages of contacts to GP were relatively constant (26%) until within 2 weeks prior to OHCA where they markedly increased (54%). In comparison, 14% of the general population contacted the GP during the same period (Figure). The weekly percentages of contacts with hospitals gradually increased in OHCA patients from 3.5% to 6.5% within 6 months, peaking at the second week (6.8%), prior to OHCA. In comparison, only 2% of the general population had a hospital contact in that period (Figure). Within 2 weeks of OHCA, patients contacted GP mainly by telephone (71.6%). Hospital diagnoses were heterogenous, where ischemic heart disease (8%) and heart failure (4.5%) were the most frequent. Conclusions There is an increase in healthcare contacts prior to “sudden” OHCA and overall, 54% of OHCA-patients had contacted GP within 2 weeks before the event. This could have implications for developing future strategies for early identification of patients prior to their cardiac arrest. Figure 1. The weekly percentages of contacts to GP (red) and hospital (blue) within one year before OHCA comparing the OHCA cases to the age- and sex-matched control population (N cases = 28,955; N controls = 260,595). Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020

Detection of high risk mortality areas after in-hospital cardiac arrest

Resuscitation ◽  
2010 ◽  
Vol 81 (2) ◽  
pp. S35
Author(s):  
J.J. Egea-Guerrero ◽  
I. Maira-Gonzalez ◽  
C. Palacios-Gómez ◽  
A. Vilches-Arenas ◽  
E. Montero-Romero ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Hospital Cardiac Arrest

scholarly journals Multiple cluster analysis for the identification of high-risk census tracts for out-of-hospital cardiac arrest (OHCA) in Denver, Colorado

Resuscitation ◽  
2014 ◽  
Vol 85 (12) ◽  
pp. 1667-1673 ◽  
Author(s):  
Ariann F. Nassel ◽  
Elisabeth D. Root ◽  
Jason S. Haukoos ◽  
Kevin McVaney ◽  
Christopher Colwell ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Cardiac Arrest ◽  
High Risk ◽  
Census Tracts ◽  
Hospital Cardiac Arrest ◽  
Multiple Cluster

Abstract 183: School-Centered CPR Education to Improve Survival from Out-of-Hospital Cardiac Arrest in High-Risk Neighborhoods

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Tom Califf ◽  
René Ramon ◽  
Wendy Morrison ◽  
Ariann Nassel ◽  
Comilla Sasson
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Low Income ◽  
Skills Training ◽  
Seventh Grade ◽  
Post Intervention ◽  
Train The Trainer ◽  
The People ◽  
Cpr Training ◽  
Hospital Cardiac Arrest

Background: Low-income and Latino neighborhoods are at high risk for having low provision of bystander CPR for victims of out-of-hospital cardiac arrest (OHCA). Novel community-based intervention is needed in these neighborhoods to increase awareness of CPR techniques and, ultimately, to decrease mortality from OHCA. Objective: To determine the feasibility of a train-the-trainer hands-only CPR program as a required assignment in a middle school. Methods: Design: Prospective survey-based interventional study. Setting: Public charter school in the Denver, CO metropolitan area. Population: Cohort of 118 subjects was recruited out of 134 eligible seventh grade students. Observations: Participants completed a 6-question test to assess baseline knowledge of CPR. Subjects then completed a group hands-only CPR training lasting 1 hour using the CPR Anytime kit, which included both an educational DVD and hands-on practical skills training with an inflatable mannequin. Participants were then asked to use these kits to train other community members over a 2-week period. At the end of the study, students were asked to complete the same 6-question survey to assess their retention of knowledge. Two-sample t-tests were conducted to assess for differences in hands-only CPR knowledge pre- and post-CPR training. Results: Demographics are given for the entire seventh grade class ( Table 1 ). Students were mostly white (71.6%), and 11 (8.2%) participated in the Free & Reduced Lunch program. Of 134 seventh graders attending the school, 118 (88%) completed a pre-intervention survey and 74 (55%) completed a post-intervention survey. Between the surveys, the mean number of questions answered correctly increased ( Table 2 ), as did performance on the question asking where to place AED pads on the chest (p < .001). Students performed poorest in both pre- and post-testing on identifying the appropriate situation for performing hands-only CPR. Conclusion: Implementation of a school-based train-the-trainee CPR education program is a feasible endeavor. Students demonstrated increased knowledge of CPR techniques two weeks after training compared to baseline. Future studies will need to be conducted to assess the people who are then trained by these students using the CPR Anytime Kits.

Abstract 55: The CAHP (Cardiac Arrest Hospital Prognosis) Score: Predicting Neurological Outcome After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Carole Maupain ◽  
Wulfran Bougouin ◽  
Lamhaut Lionel ◽  
Nicolas Deye ◽  
Daniel Jost ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Neurological Outcome ◽  
Risk Group ◽  
Unfavorable Outcome ◽  
Validation Dataset ◽  
Group Score ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
Prognosis Score

Background: Out-of-hospital cardiac arrest (OHCA) carries a very poor prognosis. Early prognostication of patients admitted in ICU after resuscitated OHCA is a key issue but remains challenging. The aim of that study was to establish a new scoring system to predict poor neurological outcome in these patients. Materials and Methods: The CAHP (Cardiac Arrest Hospital Prognosis) score was developed from the Sudden Death Expertise Center registry (SDEC, Paris, France). Objective risk factors were weighted on the basis of a logistic regression analysis. The primary outcome was poor neurological outcome defined as Cerebral Performance Category 3, 4 or 5. Thresholds were defined to distinguish low, moderate and high-risk groups. The CAHP score was then validated in an external dataset (Parisian OHCA Registry). Score calibration and discrimination characteristics were assessed in the validation dataset. Results: The developmental dataset included 819 patients admitted in ICU from May 2011 to December 2012. After logistic regression, 7 variables were independently associated with poor neurological outcome: age, initial shockable rhythm, time form collapse to basic life support (BLS), time from BLS to return of spontaneous circulation (ROSC), location of cardiac arrest, epinephrine dose during resuscitation and arterial pH at admission. These variables were included in the CAHP score. 3 risks groups were identified: a low risk group (score ≤ 150, 39 % of unfavorable outcome), medium risk group (score 150-200, 81% of unfavorable outcome) and high-risk group (CAHP score ≥ 200, 100 % of unfavorable outcome). AUC of the CAHP score was 0.93. In the external validation dataset, discrimination value of the CAHP score was consistent with an AUC of 0.85. Conclusion: The CAHP score is a simple and objective tool for early assessment of prognosis in patients admitted to ICU after OHCA. Moreover it allows to stratify the probability of poor neurological outcome by identifying a very high-risk category of patients (score ≥ 200).

Emotion Modulation in Psychiatric Patients Through Music

2012 ◽  
Vol 31 (5) ◽  
pp. 485-493 ◽  
Author(s):  
Stefan Gebhardt ◽  
Markus Kunkel ◽  
Richard von Georgi
Keyword(s):  
Substance Abuse ◽  
Problem Solving ◽  
Mental Disorders ◽  
Personality Disorders ◽  
Reference Group ◽  
Psychiatric Patients ◽  
Applied Music ◽  
Cognitive Problem ◽  
Psychiatric Population ◽  
Degree Of Severity

This study explores differences in the use of music in everyday life among diagnostic groups of a psychiatric population (n = 180) in reference to a group of healthy subjects (n = 430). The results indicate that patients with mental disorders use music more for emotion modulation than healthy controls. In particular, patients with substance abuse and those with personality disorders used music mainly for cognitive problem solving and the reduction of negative activation, whereas patients with substance abuse in addition used music not often to stimulate themselves positively. Patients suffering from schizophrenia and personality disorders more often applied music for relaxation than the subjects of the reference group. Furthermore, the degree of severity of the psychiatric disorder correlated with the increased use of music for emotion modulation, i.e., for relaxation and cognitive problem solving. Thus, the results demonstrate an increased use of music for emotion modulation in patients with mental disorders in association with the severity of the disorder.

scholarly journals Multiple sclerosis and psychiatric disorders: Comorbidity and sibling risk in a nationwide Swedish cohort

2014 ◽  
Vol 20 (14) ◽  
pp. 1881-1891 ◽  
Author(s):  
Viktoria Johansson ◽  
Cecilia Lundholm ◽  
Jan Hillert ◽  
Thomas Masterman ◽  
Paul Lichtenstein ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Bipolar Disorder ◽  
Psychiatric Disorders ◽  
Psychiatric Patients ◽  
Familial Risk ◽  
Positive Association ◽  
Protective Mechanisms ◽  
Genetic Liability ◽  
Sibling Comparison ◽  
National Patient

Background: Psychiatric disorders are known to be prevalent in multiple sclerosis (MS). Objective: The objective of this paper is to study comorbidity between MS and bipolar disorder, schizophrenia and depression in a nationwide cohort and to determine whether shared genetic liability underlies the putative association. Methods: We identified ICD-diagnosed patients with MS ( n = 16,467), bipolar disorder ( n = 30,761), schizophrenia ( n = 22,781) and depression ( n = 172,479) in the Swedish National Patient Register and identified their siblings in the Multi-Generation Register. The risk of MS was compared in psychiatric patients and in matched unexposed individuals. Shared familial risk between MS and psychiatric disorders was estimated by sibling comparison. Results: The risk of MS was increased in patients with bipolar disorder (hazard ratio (HR) 1.8, 95% confidence interval (CI) 1.6–2.2, p < 0.0001) and depression (HR 1.9, 95% CI 1.7–2.0, p < 0.0001). MS risk in schizophrenia was decreased (HR 0.6, 95% CI 0.4–0.9, p = 0.005). The association between having a sibling with a psychiatric disorder and developing MS was not significant. Conclusion: We found a strong positive association between MS and bipolar disorder and depression that could not be explained by genetic liability. The unexpected negative association between MS and schizophrenia might be spurious or indicate possible protective mechanisms that warrant further exploration.

Identifying patients at risk of futile resuscitation: palliative care indicators in out-of-hospital cardiac arrest

2019 ◽  
pp. bmjspcare-2019-001828
Author(s):  
Mia Cokljat ◽  
Adam Lloyd ◽  
Scott Clarke ◽  
Anna Crawford ◽  
Gareth Clegg
Keyword(s):  
At Risk ◽  
Palliative Care ◽  
Cardiac Arrest ◽  
High Risk ◽  
Low Risk ◽  
Intermediate Risk ◽  
Patients At Risk ◽  
Risk Patients ◽  
Record Review ◽  
Hospital Cardiac Arrest

ObjectivesPatients with indicators for palliative care, such as those with advanced life-limiting conditions, are at risk of futile cardiopulmonary resuscitation (CPR) if they suffer out-of-hospital cardiac arrest (OHCA). Patients at risk of futile CPR could benefit from anticipatory care planning (ACP); however, the proportion of OHCA patients with indicators for palliative care is unknown. This study quantifies the extent of palliative care indicators and risk of CPR futility in OHCA patients.MethodsA retrospective medical record review was performed on all OHCA patients presenting to an emergency department (ED) in Edinburgh, Scotland in 2015. The risk of CPR futility was stratified using the Supportive and Palliative Care Indicators Tool. Patients with 0–2 indicators had a ‘low risk’ of futile CPR; 3–4 indicators had an ‘intermediate risk’; 5+ indicators had a ‘high risk’.ResultsOf the 283 OHCA patients, 12.4% (35) had a high risk of futile CPR, while 16.3% (46) had an intermediate risk and 71.4% (202) had a low risk. 84.0% (68) of intermediate-to-high risk patients were pronounced dead in the ED or ED step-down ward; only 2.5% (2) of these patients survived to discharge.ConclusionsUp to 30% of OHCA patients are being subjected to advanced resuscitation despite having at least three indicators for palliative care. More than 80% of patients with an intermediate-to-high risk of CPR futility are dying soon after conveyance to hospital, suggesting that ACP can benefit some OHCA patients. This study recommends optimising emergency treatment planning to help reduce inappropriate CPR attempts.

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