Lower Proportion of Fatal Arrhythmia in Sudden Cardiac Arrest Among Patients With Severe Mental Illness Than Nonpsychiatric Patients
Lower Proportion of Fatal Arrhythmia in Sudden Cardiac Arrest Among Patients With Severe Mental Illness Than Nonpsychiatric Patients
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DOI：
10.1016/j.psym.2019.08.005
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发表时间：
2020-01-01
期刊：
影响因子：
3.4
通讯作者：
Uchida, Hiroyuki
中科院分区：
文献类型：
--
作者：
Ishida, Takuto;Sugiyama, Kazuhiro;Uchida, Hiroyuki
背景：突发意外死亡在严重精神疾病(SMI)患者中更为常见，但关于其原因的直接证据仍然很少。目的：研究重度心肌梗死患者院外心脏骤停的起搏节律和特点。方法：我们对2011年1月至2017年12月期间因院外心脏骤停而转至日本东京都Bokutoh医院的成年患者进行了系统的图表回顾。比较了精神分裂症或心境障碍(即SMI)患者和非精神对照组患者的初始节律、临床特征和结果。根据需要使用Fisher精确检验或Mann-Whitney U检验比较感兴趣值。采用多元回归分析的方法研究SMI对初始节律的影响。结果：本研究共纳入2631例患者。在这些患者中，157名患者患有SMI。致死性心律失常(即室颤和室性心动过速)在重度心肌梗死患者中的发生率低于对照组(5.7%比18.8%，调整后优势比=0.27，95%可信区间=0.13-0.55，P<；0.001)。与对照组相比，重度心肌梗死患者显著年轻(中位数[范围]58岁[22-85岁]对72岁[18-108]，P<；0.001)并且较少合并身体疾病(无合并症的患者比例：58.6%对37.1%，P<；0.001)。两组患者的存活率和出院时的神经功能均无差异。结论：在SMI患者中，致死性心律失常可能占猝死的比例相对较小，此外，对SMI患者进行早期适当的体检对预防心源性猝死具有重要意义。
Background: Sudden unexpected deaths occur more frequently among patients with severe mental illness (SMI), but direct evidence on the causes is still scarce. Objective: The objective of this study is to investigate initial rhythms and characteristics of out-of-hospital cardiac arrest among patients with SMI. Methods: We conducted a systematic chart review of adult patients who suffered from out-of-hospital cardiac arrest and transferred to Tokyo Metropolitan Bokutoh Hospital in Japan between January 2011 and December 2017. The initial rhythms, clinical characteristics, and outcomes were compared between patients with schizophrenia or mood disorders (i.e., SMI) and nonpsychiatric control patients. Values of interest were compared using Fisher's exact test or Mann-Whitney U-test, as appropriate. Multiple regression analysis was also conducted to investigate the effect of SMI on the initial rhythms. Results: A total of 2631 patients were included in this study. Of these, 157 patients had SMI. Fatal arrhythmias (i.e., ventricular fibrillation and ventricular tachycardia) were less frequently noted as the initial rhythms among patients with SMI than among controls (5.7% vs. 18.8%, adjusted odds ratio = 0.27, 95% confidence interval = 0.13-0.55, P < 0.001). Patients with SMI were significantly younger (median [range], 58 years [22-85] vs. 72 years [18-108], P < 0.001) and less frequently had comorbid physical illnesses than controls (the proportion of patients without comorbidities; 58.6% vs. 37.1%, P < 0.001). Survival and neurological function at discharge were not different between the 2 groups. Conclusion: Fatal arrhythmia may account for a relatively small portion in excess of sudden death among patients with SMI Furthermore, appropriate medical checkups for the patients with SMI at earlier ages would be important to prevent sudden cardiac death.