Out‐of‐Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter‐Defibrillator and Survival
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 w...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.012708 |
| _version_ | 1819178506947395584 |
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| author | Carlo Alberto Barcella Grimur Høgnason Mohr Kristian Hay Kragholm Thomas Alexander Gerds Svend Eggert Jensen Christoffer Polcwiartek Mads Wissenberg Freddy Knudsen Lippert Christian Torp‐Pedersen Lars Vedel Kessing Gunnar Hilmar Gislason Kathrine Bach Søndergaard |
| author_facet | Carlo Alberto Barcella Grimur Høgnason Mohr Kristian Hay Kragholm Thomas Alexander Gerds Svend Eggert Jensen Christoffer Polcwiartek Mads Wissenberg Freddy Knudsen Lippert Christian Torp‐Pedersen Lars Vedel Kessing Gunnar Hilmar Gislason Kathrine Bach Søndergaard |
| author_sort | Carlo Alberto Barcella |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-22T21:43:39Z |
| format | Article |
| id | doaj.art-08c9f1832904468fb6d65ebecc9e5704 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:43:39Z |
| publishDate | 2019-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-08c9f1832904468fb6d65ebecc9e57042022-12-21T18:11:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-08-0181610.1161/JAHA.119.012708Out‐of‐Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter‐Defibrillator and SurvivalCarlo Alberto Barcella0Grimur Høgnason Mohr1Kristian Hay Kragholm2Thomas Alexander Gerds3Svend Eggert Jensen4Christoffer Polcwiartek5Mads Wissenberg6Freddy Knudsen Lippert7Christian Torp‐Pedersen8Lars Vedel Kessing9Gunnar Hilmar Gislason10Kathrine Bach Søndergaard11Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup DenmarkDepartment of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkDepartment of Biostatistics University of Copenhagen DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkDepartment of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup DenmarkEmergency Medical Services The Capital Region of Denmark Copenhagen DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkPsychiatric Center Copenhagen Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup DenmarkDepartment of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup DenmarkBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.119.012708cardiovascular procedureshealthcare disparitiesin‐hospital post‐arrest managementout‐of‐hospital cardiac arrestpsychiatric disorders |
| spellingShingle | Carlo Alberto Barcella Grimur Høgnason Mohr Kristian Hay Kragholm Thomas Alexander Gerds Svend Eggert Jensen Christoffer Polcwiartek Mads Wissenberg Freddy Knudsen Lippert Christian Torp‐Pedersen Lars Vedel Kessing Gunnar Hilmar Gislason Kathrine Bach Søndergaard Out‐of‐Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter‐Defibrillator and Survival Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular procedures healthcare disparities in‐hospital post‐arrest management out‐of‐hospital cardiac arrest psychiatric disorders |
| title | Out‐of‐Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter‐Defibrillator and Survival |
| title_full | Out‐of‐Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter‐Defibrillator and Survival |
| title_fullStr | Out‐of‐Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter‐Defibrillator and Survival |
| title_full_unstemmed | Out‐of‐Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter‐Defibrillator and Survival |
| title_short | Out‐of‐Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter‐Defibrillator and Survival |
| title_sort | out of hospital cardiac arrest in patients with and without psychiatric disorders differences in use of coronary angiography coronary revascularization and implantable cardioverter defibrillator and survival |
| topic | cardiovascular procedures healthcare disparities in‐hospital post‐arrest management out‐of‐hospital cardiac arrest psychiatric disorders |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.012708 |
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