Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness
Background ECG abnormalities are associated with adverse outcomes in the general population, but their prognostic significance in severe mental illness (SMI) remains unexplored. We investigated associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) among p...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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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.120.019416 |
| _version_ | 1818312214136750080 |
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| author | Christoffer Polcwiartek Brett D. Atwater Kristian Kragholm Daniel J. Friedman Carlo A. Barcella Rubina Attar Claus Graff Jonas B. Nielsen Adrian Pietersen Peter Søgaard Christian Torp‐Pedersen Svend E. Jensen |
| author_facet | Christoffer Polcwiartek Brett D. Atwater Kristian Kragholm Daniel J. Friedman Carlo A. Barcella Rubina Attar Claus Graff Jonas B. Nielsen Adrian Pietersen Peter Søgaard Christian Torp‐Pedersen Svend E. Jensen |
| author_sort | Christoffer Polcwiartek |
| collection | DOAJ |
| description | Background ECG abnormalities are associated with adverse outcomes in the general population, but their prognostic significance in severe mental illness (SMI) remains unexplored. We investigated associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) among patients with SMI compared with controls without mental illness. Methods and Results We cross‐linked data from Danish nationwide registries and included primary care patients with digital ECGs from 2001 to 2015. Patients had SMI if they were diagnosed with schizophrenia, bipolar disorder, or severe depression before ECG recording. Controls were required to be without any prior mental illness or psychotropic medication use. Fatal CVD was assessed using hazard ratios (HRs) with 95% CIs and standardized 10‐year absolute risks. Of 346 552 patients, 10 028 had SMI (3%; median age, 54 years; male, 45%), and 336 524 were controls (97%; median age, 56 years; male, 48%). We observed an interaction between SMI and ECG abnormalities on fatal CVD (P<0.001). Severe mental illness was associated with fatal CVD across no (HR, 2.17; 95% CI, 1.95–2.43), minor (HR, 1.90; 95% CI, 1.49–2.42), and major (HR, 1.40; 95% CI, 1.26–1.55) ECG abnormalities compared with controls. Across age‐ and sex‐specific subgroups, SMI patients with ECG abnormalities but no CVD at baseline had highest standardized 10‐year absolute risks of fatal CVD. Conclusions ECG abnormalities conferred a poorer prognosis among patients with SMI compared with controls without mental illness. SMI patients with ECG abnormalities but no CVD represent a high‐risk population that may benefit from greater surveillance and risk management. |
| first_indexed | 2024-12-13T08:14:17Z |
| format | Article |
| id | doaj.art-a8db5b2be3704ba198ebd19737099afd |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:14:17Z |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-a8db5b2be3704ba198ebd19737099afd2022-12-21T23:54:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-01-0110210.1161/JAHA.120.019416Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental IllnessChristoffer Polcwiartek0Brett D. Atwater1Kristian Kragholm2Daniel J. Friedman3Carlo A. Barcella4Rubina Attar5Claus Graff6Jonas B. Nielsen7Adrian Pietersen8Peter Søgaard9Christian Torp‐Pedersen10Svend E. Jensen11Department of Cardiology Aalborg University Hospital Aalborg DenmarkDivision of Cardiology Duke University Medical Center Durham NCDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkSection of Cardiac Electrophysiology Yale School of Medicine New Haven CTDepartment of Cardiology Copenhagen University Hospital Gentofte Hellerup DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkDepartment of Health Science and Technology Aalborg University Aalborg DenmarkLaboratory for Molecular Cardiology The Heart CenterCopenhagen University HospitalRigshospitalet Copenhagen DenmarkCopenhagen General Practitioners' Laboratory Copenhagen DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkBackground ECG abnormalities are associated with adverse outcomes in the general population, but their prognostic significance in severe mental illness (SMI) remains unexplored. We investigated associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) among patients with SMI compared with controls without mental illness. Methods and Results We cross‐linked data from Danish nationwide registries and included primary care patients with digital ECGs from 2001 to 2015. Patients had SMI if they were diagnosed with schizophrenia, bipolar disorder, or severe depression before ECG recording. Controls were required to be without any prior mental illness or psychotropic medication use. Fatal CVD was assessed using hazard ratios (HRs) with 95% CIs and standardized 10‐year absolute risks. Of 346 552 patients, 10 028 had SMI (3%; median age, 54 years; male, 45%), and 336 524 were controls (97%; median age, 56 years; male, 48%). We observed an interaction between SMI and ECG abnormalities on fatal CVD (P<0.001). Severe mental illness was associated with fatal CVD across no (HR, 2.17; 95% CI, 1.95–2.43), minor (HR, 1.90; 95% CI, 1.49–2.42), and major (HR, 1.40; 95% CI, 1.26–1.55) ECG abnormalities compared with controls. Across age‐ and sex‐specific subgroups, SMI patients with ECG abnormalities but no CVD at baseline had highest standardized 10‐year absolute risks of fatal CVD. Conclusions ECG abnormalities conferred a poorer prognosis among patients with SMI compared with controls without mental illness. SMI patients with ECG abnormalities but no CVD represent a high‐risk population that may benefit from greater surveillance and risk management.https://www.ahajournals.org/doi/10.1161/JAHA.120.019416ECGprimary carerisk predictionsevere mental illness |
| spellingShingle | Christoffer Polcwiartek Brett D. Atwater Kristian Kragholm Daniel J. Friedman Carlo A. Barcella Rubina Attar Claus Graff Jonas B. Nielsen Adrian Pietersen Peter Søgaard Christian Torp‐Pedersen Svend E. Jensen Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ECG primary care risk prediction severe mental illness |
| title | Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness |
| title_full | Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness |
| title_fullStr | Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness |
| title_full_unstemmed | Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness |
| title_short | Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness |
| title_sort | association between ecg abnormalities and fatal cardiovascular disease among patients with and without severe mental illness |
| topic | ECG primary care risk prediction severe mental illness |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.019416 |
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