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Arrhythmias and sudden death
Original research
Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia
  1. Carlo Alberto Barcella1,
  2. Grimur Mohr1,
  3. Kristian Kragholm2,
  4. Daniel Christensen1,3,
  5. Thomas A Gerds3,4,
  6. Christoffer Polcwiartek2,5,
  7. Mads Wissenberg1,
  8. Casper Bang6,7,
  9. Fredrik Folke1,
  10. Christian Torp-Pedersen6,
  11. Lars Vedel Kessing8,
  12. Gunnar Hilmar Gislason1,
  13. Kathrine Bach Søndergaard1
  1. 1 Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Copenhagen, Denmark
  2. 2 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
  3. 3 The Danish Heart Foundation, Copenhagen, Denmark
  4. 4 Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
  5. 5 Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
  6. 6 Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerod, Denmark
  7. 7 Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
  8. 8 Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Carlo Alberto Barcella, Cardiology, Gentofte Hospital, 2900 Hellerup, Denmark; carlo.alberto.barcella{at}regionh.dk

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.

  • ventricular arrhythmia ablation procedures
  • cardiac arrest
  • cardiac risk factors and prevention
  • ventricular tachycardia
  • epidemiology

Data availability statement

No data are available. The data, analytical methods and study materials cannot be made available to other researchers for purposes of reproducing the results or replicating the procedure.

https://doi.org/10.1136/heartjnl-2020-318078

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    Data availability statement

    No data are available. The data, analytical methods and study materials cannot be made available to other researchers for purposes of reproducing the results or replicating the procedure.

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    Footnotes

    • Contributors Concept and design: CAB, GM, GHG, CT-P, TAG, LVK. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: CAB, KBS, GM. Critical revision of the manuscript for important intellectual content: KK, GM, GHM, TAG, CT-P, CP, CB, FF, LVK, KBS. Statistical analysis: CAB, GHG, TAG, DC, CT-P, GM. Administrative, technical or material support: CAB, MW, CP, GM, GHG, KK, CT-P, FF.

    • Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme ESCAPE-NET under grant agreement no. 733381.

    • Competing interests CP reported receiving speaking fees from Lundbeck Pharma A/S and research grants from the Danish Heart Foundation and Eva and Henry Frænkel Memorial Foundation. LVK received speaking fees from Lundbeck Pharma A/S during recent 3 years. CB reported receiving speaking fees from Bayer A/S during recent 3 years. All remaining authors have declared no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.