Mortality risk grows with depression, anxiety after surviving cardiac arrest
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Key takeaways:
- Survivors of out-of-hospital cardiac arrest with anxiety or depression were more likely to die during 14 years of follow-up.
- Psychological as well as neurological rehabilitation could improve survival.
Adults who survived an out-of-hospital cardiac arrest and developed depression or anxiety within 1 year were 1.4 times more likely to die during follow-up compared with those without a mental health diagnosis, researchers reported.
Due to increasing rates rate of good prognoses for patients with out-of-hospital cardiac arrest, long-term outcomes would also be increased, Jaehoon Oh, MD, PhD, of the department of emergency medicine at Hanyang University College of Medicine in Seoul, South Korea, and colleagues wrote in JAMA Network Open. Surviving patients could develop neurologic sequelae caused by both initial anoxia and subsequent ischemia-reperfusion injury, and such sequelae could affect their physical, cognitive and psychosocial characteristics.
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“A systematic review and meta-analysis recently reported that the prevalence of psychiatric disorders in survivors of out-of-hospital cardiac arrest was higher than that in the general population, stressing the importance of improving physical and mental outcomes in individuals who experience out-of-hospital cardiac arrest,” the researchers wrote.
In a population-based study, Oh and colleagues analyzed data from 2,373 patients hospitalized for out-of-hospital cardiac arrest between 2005 and 2015 who survived for 1 year or longer (mean age, 53 years; 78.4% men). Patients with cardiac arrest due to traumatic or nonmedical causes were excluded. Researchers assessed data on depression or anxiety diagnoses within 1 year, using the Korean National Health Insurance Service database and followed the cohort for 14 years. The primary outcome was long-term cumulative mortality with vs. without a diagnosis of depression or anxiety.
Within the cohort, 16.7% of patients were diagnosed with depression or anxiety, including 10.6% with a depression diagnosis and 9.6% with an anxiety diagnosis.
The incidence of long-term mortality was significantly higher in the group diagnosed with depression or anxiety vs. the group without depression or anxiety (35.5% vs. 27%; P = .001).
In a multivariate Cox proportional hazards model, the adjusted HR for long-term mortality was 1.41 for all patients with depression or anxiety (95% CI, 1.17-1.7); 1.44 for those with a depression diagnosis (95% CI, 1.16-1.79); and 1.2 for those with an anxiety diagnosis (95% CI, 0.94-1.53).
“Because the present study identified an association between psychological dysfunction and an increase in long-term mortality, we believe it provides evidence that psychological rehabilitation of patients with out-of-hospital cardiac arrest is crucial,” the researchers wrote. “In addition, we noted that providing adequate rehabilitation benefited not only the patient's health-related quality of life but also long-term survival.”
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