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Cardiovascular morbidity in high-risk patients during ECT
E H Rice1, L B Sombrotto, J C Markowitz
1Department of Psychiatry, New York Hospital-Cornell Medical Center, Payne Whitney Psychiatric Clinic, New York, White Plains 10605.
Insights
Electroconvulsive therapy (ECT) is relatively safe for elderly patients with cardiac conditions. Advances in ECT techniques and careful patient management have significantly reduced major cardiac complications.
Area of Science:
- Cardiology
- Psychiatry
- Geriatrics
Background:
- Cardiovascular events are a primary cause of morbidity in patients undergoing electroconvulsive therapy (ECT).
- Assessing the safety of ECT in patients with pre-existing cardiovascular disease is crucial for clinical practice.
Purpose of the Study:
- To evaluate the medical complications associated with ECT in older patients with pre-existing cardiovascular disease.
- To compare the risks of ECT in patients stratified by cardiac risk factors.
Main Methods:
- A case-control study reviewed 80 patients over 50 years old who received ECT between August 1990 and August 1991.
- Patients were divided into increased cardiac risk (N=26) and standard cardiac risk (N=27) groups based on clinical criteria.
- Medical complications were assessed using a standardized scale.
Main Results:
- The increased cardiac risk group was older and received more pre-ECT consultations.
- While minor complications were more frequent in the risk group, major complications did not significantly differ between groups.
- No deaths or permanent cardiac morbidity occurred during ECT.
Conclusions:
- ECT is relatively safe for elderly patients with cardiac risk factors, contrary to earlier findings.
- Improvements in ECT techniques and pre-ECT risk factor management have enhanced patient safety.
- Careful identification and management of cardiac risk factors are essential for safe ECT administration.
Objective:
Cardiovascular events are the principal cause of medical morbidity in patients receiving ECT. To assess the risks of ECT for individuals with preexisting cardiovascular disease, the authors examined medical complications in older patients treated with ECT during a 1-year period.
Method:
A case-control design was used in a review of the charts of 80 consecutive patients who received ECT from August 1990 to August 1991. On the basis of accepted clinical criteria, patients over 50 years of age were divided into two groups: one at increased risk for cardiac complications (N = 26) and one at standard cardiac risk (N = 27). Outcome was measured with a scale designed to assess clinically relevant medical complications.
Results:
The risk group was older and had received more medical consultations before ECT than the nonrisk group. Although patients in the risk group were more likely to develop minor complications during ECT, they did not differ significantly from the comparison group in the rate of major complications. No patients died or sustained permanent cardiac morbidity during ECT.
Conclusions:
In contrast to a similar study at the same site 15 years earlier, the current study found ECT to be relatively safe in an unselected study group of elderly patients with preexisting cardiac risk factors. The findings underscore the advances in ECT technique over the past 15 years and the importance of identifying and carefully managing patients with cardiac risk factors before and during ECT.