Schizophrenic individuals have increased risk for sudden cardiac death
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Key takeaways:
- Individuals with schizophrenia accounted for 11% of young people who had sudden cardiac death.
- Social isolation factors were often present in individuals with schizophrenia who experienced sudden cardiac death.
Young people with schizophrenia had elevated risk for sudden cardiac death, and biopsychosocial factors related to social isolation impacted the cardiac risk factor burden in individuals with schizophrenia, researchers reported.
In addition, researchers wrote that among young people with sudden cardiac death who were referred for autopsy, individuals with schizophrenia were more likely to have nonischemic cardiomyopathy compared with individuals without schizophrenia.
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“This study is the first to explore the impact of biopsychosocial factors such as social isolation on the association of schizophrenia and cardiac arrest specifically, but our findings suggest that these are a critical part of the puzzle,” Elizabeth D. Paratz, MBBS, PhD, of the Baker Heart & Diabetes Institute in Australia, and colleagues wrote in JACC: Clinical Electrophysiology.
To determine the difference in characteristics of increased sudden cardiac death in individuals with and without schizophrenia, Paratz and colleagues analyzed 579 individuals aged 15 to 50 years both with and without schizophrenia who had experienced sudden cardiac death from the End Unexplained Cardiac Death prospective statewide cardiac arrest clinical registry in Australia. Researchers used cases that were referred to forensic services for investigation between April 2019 and April 2021.
Researchers also analyzed patient medication histories and postmortem toxicology reports to identify individuals found with the presence of QTc-prolonging medications.
Paratz and colleagues found that individuals with schizophrenia were more likely to smoke (46.2% vs. 23%; P < .0001), consume excess alcohol (32.3% vs. 21.4%; P = .05) and take QTc-prolonging medications (69.2% vs. 17.9%; P < .0001) compared with individuals without schizophrenia.
In addition, individuals with schizophrenia were less likely to experience a sudden cardiac arrest while exercising (0% vs. 6.4%; P = .04) compared with individuals without schizophrenia.
Meanwhile, individuals with schizophrenia had lower rates of witnessed cardiac arrest (6.2% vs. 23.5%; P < .0001), were more likely to be found in asystole (92.3% vs. 73.3%; P < .0001), were more likely to be found during a welfare check after a prolonged period of time had elapsed since cardiac arrest (median time elapsed when found, 42 hours vs. 12 hours; P = .003), had more frequent evidence of postmortem decomposition (41.2% vs. 26.4%; P = .05) and were more likely to undergo an autopsy (93.8% vs. 82.5%; P = .04) compared with individuals without schizophrenia.
Additionally, in what the authors said was a novel finding, individuals with schizophrenia were more likely to have a diagnosis of nonischemic cardiomyopathy (29.2% vs. 18.1%; P = .04) compared with individuals without schizophrenia.
“In constructing the chain of survival, prompt cardiopulmonary resuscitation and defibrillation confer the best odds of surviving a cardiac arrest,” the researchers wrote. “The unwitnessed nature and prolonged isolation of many patients with schizophrenia in this study contributed to high numbers of fatalities.”
Therefore, “Strategies targeting improving social support networks and community integration of people with schizophrenia may deliver not only psychological benefits, but also be a tangibly useful mechanism of reducing unwitnessed cardiac arrest,” Paratz and colleagues wrote.
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