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Out-of-Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary
Carlo Alberto Barcella1, Grimur Høgnason Mohr1,2, Kristian Hay Kragholm3,4,5
1Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.
Insights
Patients with psychiatric disorders received fewer cardiovascular procedures after out-of-hospital cardiac arrest (OHCA) and had lower survival rates. This highlights significant healthcare disparities in post-OHCA management for this vulnerable population.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Healthcare disparities are prevalent for psychiatric patients.
- The impact of psychiatric disorders on post-resuscitation management following out-of-hospital cardiac arrest (OHCA) remains underexplored.
Purpose of the Study:
- To investigate disparities in in-hospital cardiovascular procedures after OHCA between patients with and without psychiatric disorders.
- To assess differences in survival rates based on psychiatric status post-OHCA.
Main Methods:
- Utilized Danish nationwide registries (2001-2015) to identify patients hospitalized after OHCA of presumed cardiac cause.
- Identified psychiatric disorders through hospital diagnoses or psychotropic drug prescriptions.
- Calculated standardized incidence rates and incidence rate ratios for cardiovascular procedures and assessed survival using multivariable logistic regression.
Main Results:
- Patients with psychiatric disorders had significantly lower rates of acute and subacute coronary angiography (CAG) and implantable cardioverter-defibrillator (ICD) implantation post-OHCA.
- No significant difference was observed in coronary revascularization rates among patients who underwent CAG.
- Patients with psychiatric disorders exhibited lower 30-day and 1-year survival rates, even among those receiving acute CAG.
Conclusions:
- Psychiatric patients experience reduced access to critical post-OHCA cardiovascular interventions like CAG and ICD implantation.
- Despite similar revascularization rates when undergoing CAG, psychiatric patients face poorer survival outcomes post-OHCA.
- These findings underscore significant healthcare disparities in cardiac arrest care for individuals with psychiatric disorders.
Abstract:
Background Healthcare disparities for psychiatric patients are common. Whether these inequalities apply to postresuscitation management in out-of-hospital cardiac arrest (OHCA) is unknown. We investigated differences in in-hospital cardiovascular procedures following OHCA between patients with and without psychiatric disorders. Methods and Results Using the Danish nationwide registries, we identified patients admitted to the hospital following OHCA of presumed cardiac cause (2001-2015). Psychiatric disorders were identified using hospital diagnoses or redeemed prescriptions for psychotropic drugs. We calculated age- and sex-standardized incidence rates and incidence rate ratios (IRRs) of cardiovascular procedures during post-OHCA admission in patients with and without psychiatric disorders. Differences in 30-day and 1-year survival were assessed by multivariable logistic regression in the overall population and among 2-day survivors who received acute coronary angiography (CAG). We included 7288 hospitalized patients who had experienced an OHCA: 1661 (22.8%) had a psychiatric disorder. Compared with patients without psychiatric disorders, patients with psychiatric disorders had lower standardized incidence rates for acute CAG (≤1 day post-OHCA) (IRR, 0.51; 95% CI, 0.45-0.57), subacute CAG (2-30 days post-OHCA) (IRR, 0.40; 95% CI, 0.30-0.52), and implantable cardioverter-defibrillator implantation (IRR, 0.67; 95% CI, 0.48-0.95). Conversely, we did not detect differences in coronary revascularization among patients undergoing CAG (IRR, 1.11; 95% CI, 0.94-1.30). Patients with psychiatric disorders had lower survival even among 2-day survivors who received acute CAG: (odds ratio of 30-day survival, 0.68; 95% CI, 0.52-0.91; and 1-year survival, 0.66; 95% CI, 0.50-0.88). Conclusions Psychiatric patients had a lower probability of receiving post-OHCA CAG and implantable cardioverter-defibrillator implantation compared with nonpsychiatric patients but the same probability of coronary revascularization among patients undergoing CAG. However, their survival was lower irrespective of angiographic procedures.
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