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From the Journals

Mental Health Tied to Early Heart Deaths

Danish study of 4.3 million residents reveals psychiatric patients face up to 6.45 times higher risk of sudden cardiac death, with schizophrenia patients showing the highest hazard ratio of 4.51 compared to the general population.

Conexiant

A nationwide Danish study found that patients with psychiatric disorders experienced significantly higher rates of sudden cardiac death across all age groups from 18 to 90 years. 

In the study, published in Heart, investigators examined the data from 4.3 million Danish residents in 2010. They identified 732,288 patients with psychiatric disorders. Among 45,703 total deaths recorded during the 1-year follow-up period, 6,002 of them were attributed to sudden cardiac death (SCD), with 2,319 of them occurring in psychiatric patients.

The data showed that psychiatric disorders were associated with SCD (hazard ratio [HR] = 2.31, 95% confidence interval [CI] = 2.19–2.43, P < .001) after adjusting for age, sex, and cardiovascular comorbidities. Patients with schizophrenic disorders showed an HR of 4.51 (95% CI = 3.95–5.16, P < .001), bipolar disorder showed an HR of 2.93 (95% CI = 2.36–3.62, P < .001), and depressive disorders showed an HR of 2.10 (95% CI = 1.92–2.30, P < .001).

The investigators analyzed deaths using autopsy reports, death certificates, and national health registers. They defined psychiatric disorders through ICD-10 codes within 10 years before the study initiation or redemption of psychotropic medication prescriptions within the previous 1 year.

Among patients aged 18 to 40 years, SCD accounted for 13% of excess life-years lost and 17% of losses as a result of natural deaths. The incidence rate ratio of SCD was highest in individuals under 50 years and decreased with age.

The study population with psychiatric disorders showed these comorbidity rates:

  • Heart failure: 5.6% vs 1.1% in general population
  • Arrhythmic disease: 5.7% vs 3.1%
  • Ischemic heart disease: 8.1% vs 4.2%
  • Cerebral disease: 7.2% vs 2.3%
  • Other cardiovascular disease: 20% vs 11%.

The methodology included a review of all deaths, with SCD classified according to European Society of Cardiology criteria. The investigators used multivariable Cox proportional hazards models for statistical analysis, with age as the primary time scale.

Study limitations included its observational nature, reliance on register-based data, and the 2010 timeframe. The data represented Danish demographics and health care systems. 

Conflict of interest disclosures can be found in the study.