Postevent depression and anxiety associated with higher long-term mortality risk among survivors of an out-of-hospital cardiac arrest (OHCA), according to results of a study published in JAMA Network Open.
Survival after an OHCA has improved in recent years, however, survivors are at risk for long-term sequelae and mortality.
This population-based cohort study was conducted to evaluate whether patients with psychiatric disorders may be at increased risk for poorer outcomes after surviving an OHCA. To that end, investigators from Hanyang University in Seoul, South Korea sourced data for this study from the Korean National Health Insurance Service (NHIS). Patients (N=2373) with a primary diagnosis of cardiac arrest between 2005 and 2015 that did not occur in-hospital were evaluated for long-term cumulative mortality through 2018 on the basis of depression or anxiety.
Patients were aged 40 to 49 (21.9%) and 50 to 59 (29.2%) years, 78.4% were men, and 29.4% had a Charlson comorbidity index of 0. Overall, there were 397 patients with depression or anxiety. Patients with and without depression and anxiety were well-balanced for age, gender, and comorbidity scores.
The rate of long-term mortality during follow-up was 28.4%. Mortality rates were higher among the subset of patients with depression or anxiety compared with those without (35.5% vs 27.0%; P =.001), respectively.
In the adjusted analysis, mortality was associated with depression or anxiety (adjusted hazard ratio [aHR], 1.41; 95% CI, 1.17-1.70). Stratified by disorder, the significant association was driven by depression (aHR, 1.44; 95% CI, 1.16-1.79) not by anxiety (aHR, 1.20; 95% CI, 0.94-1.53).
When data were stratified by time of diagnosis, no significant association with mortality was observed among those with depression or anxiety diagnosed within 3 years prior to OHCA (aHR, 1.06; 95% CI, 0.91-1.23) whereas depression or anxiety diagnosed after OHCA was associated with mortality risk compared with controls (aHR, 1.41; 95% CI, 1.17-1.70).
Among decedents with and without depression and anxiety, 21.2% and 16.1% of patients died of noncardiovascular causes, 14.2% and 10.9% died of cardiovascular-associated causes, and 1.8% and 0.9% died of injury, respectively. Depression and anxiety associated with mortality due to cardiovascular causes (aHR, 1.41; 95% CI, 1.05-1.89) and noncardiovascular causes (aHR, 1.41; 95% CI, 1.11-1.80) but not mortality from injury (aHR, 2.34; 95% CI, 0.97-5.68).
This study may have been limited by not having access to data about cardiac arrest characteristics.
Study authors concluded, “Among patients who survived OHCA, those diagnosed with a psychiatric disorder had a higher long-term mortality rate. The findings of this study suggest that it may be important to provide psychological as well as neurologic rehabilitation to individuals after OHCA to help improve long-term survival.”
Lee J, Cho Y, Oh J, et al. Analysis of anxiety or depression and long-term mortality among survivors of out-of-hospital cardiac arrest. JAMA Netw Open. 2023;6(4):e237809. doi:10.1001/jamanetworkopen.2023.7809