Postmortem analysis of cardiovascular deaths in schizophrenia: A 10-year review

Sweeting, J.; Duflou, Johan; Semsarian, Christopher

doi:10.1016/j.schres.2013.08.029

Cited by 45 publications

(32 citation statements)

References 32 publications

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“…Previous reports using autopsy findings have identified cardiovascular disease as the principal cause of sudden unexpected death, with rates ranging from 20% to 63% . In the present study, cardiac disease was still the leading cause of OHCA in patients with psychiatric disorders, but the proportion of cardiac disease was significantly lower than in controls.…”

Section: Discussioncontrasting

confidence: 41%

Etiology of out‐of‐hospital cardiac arrest in psychiatric patients: Chart review

Ishida

Miyazaki

Yukawa

et al. 2019

Psychiatry Clin Neurosci

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Aim Although sudden cardiac deaths are more common in psychiatric patients than the general population, data on their causes are very limited. The aim of this study was to investigate initial rhythms and causes of out‐of‐hospital cardiac arrest (OHCA) in patients with psychiatric disorders. Methods We conducted a systematic chart review of patients resuscitated after OHCA and hospitalized in the Tertiary Emergency Medical Center of Tokyo Metropolitan Bokutoh Hospital in Japan between January 2010 and December 2017. The initial rhythms and causes of OHCA were compared between psychiatric patients and non‐psychiatric patients. Parameters of interest were compared using chi‐squared test, Fisher's exact test, or the Mann–Whitney U‐test, as appropriate. Results A total of 49 psychiatric and 600 non‐psychiatric patients were eligible for this study. Fatal but shockable arrhythmias (i.e. ventricular fibrillation and ventricular tachycardia) were less frequently observed as initial rhythms in patients with psychiatric disorders than the others (22.4% vs 49.7%, P < 0.001). Cardiac origin was less common as the cause of OHCA (26.5% vs 58.5%, P < 0.01), while airway obstruction and pulmonary embolism were more frequent in psychiatric versus non‐psychiatric patients (24.5% vs 6.5%, P < 0.01; and 12.2% vs 1.5%, P < 0.01, respectively). The results were similar when psychiatric patients were compared with sex‐ and age‐matched controls selected from the non‐psychiatric patient group. Conclusion Although fatal arrhythmias may be less common, non‐cardiac causes such as pulmonary embolism and airway obstruction need to be treated with high clinical suspicion in an event of sudden cardiac arrest in psychiatric patients.

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Section: Discussioncontrasting

confidence: 41%

Etiology of out‐of‐hospital cardiac arrest in psychiatric patients: Chart review

Ishida

Miyazaki

Yukawa

et al. 2019

Psychiatry Clin Neurosci

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“…Another recent prospective study from Sweden, Finland, and Denmark using registers found similar SMRs (range 1.6–2.5) for CVD-related deaths in all the three countries, and life expectancies were 15–20 years shorter than in the general population (11). The increased rates of CVD-related deaths have been confirmed also in autopsy studies (20). …”

Section: Cardiovascular Disease-related Deaths In Schizophreniamentioning

confidence: 62%

Increased Mortality in Schizophrenia Due to Cardiovascular Disease â€“ A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

et al. 2014

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Background: Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed.Methods: Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors’ experience from clinical work and research in the field.Results: In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population.Discussion: The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

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“…Indeed, it is well established that schizophrenia is significantly associated with an increased cardiovascular risk. People with schizophrenia are almost two times more likely to die from cardiovascular diseases (CVD) (Brown et al, 2010;Sweeting et al, 2013). The etiology of this increased risk for CVD is multifactorial and includes conventional risk factors, such as genetic and lifestyle factors, as well as drug side-effects (DE Hert et al, 2011;Vancampfort et al, 2013).…”

Section: Age Metabolism and Cardiovascular Risk In Schizophreniamentioning

confidence: 99%