TY - JOUR
T1 - Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study
AU - Fernando, Shannon M.
AU - Qureshi, Danial
AU - Talarico, Robert
AU - Vigod, Simone N.
AU - McIsaac, Daniel I.
AU - Sterling, Lee H.
AU - van Diepen, Sean
AU - Price, Susanna
AU - Di Santo, Pietro
AU - Kyeremanteng, Kwadwo
AU - Fan, Eddy
AU - Needham, Dale M.
AU - Brodie, Daniel
AU - Bienvenu, Oscar Joseph
AU - Combes, Alain
AU - Slutsky, Arthur S.
AU - Scales, Damon C.
AU - Herridge, Margaret S.
AU - Thiele, Holger
AU - Hibbert, Benjamin
AU - Tanuseputro, Peter
AU - Mathew, Rebecca
N1 - Publisher Copyright:
© Springer-Verlag GmbH Germany, part of Springer Nature 2024.
PY - 2024/6
Y1 - 2024/6
N2 - Purpose: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge. Methods: We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18 years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019. We compared these patients to AMI survivors without shock. We captured outcome data using linked health administrative databases. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia/psychotic disorders; and other mental health disorders) following hospital discharge. We secondarily evaluated incidence of deliberate self-harm and death by suicide. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. Results: We included 7812 consecutive survivors of AMI-CS, from 135 centers. Mean age was 68.4 (standard deviation (SD) 12.2) years, and 70.3% were male. Median follow-up time was 767 days (interquartile range (IQR) 225–1682). Incidence of new mental health diagnosis among AMI-CS survivors was 109.6 per 1,000 person-years (95% confidence interval (CI) 105.4–113.9), compared with 103.8 per 1000 person-years (95% CI 102.5–105.2) among AMI survivors without shock. After propensity score adjustment, there was no difference in the risk of new mental health diagnoses following discharge [hazard ratio (HR) 0.99 (95% CI 0.94–1.03)]. Factors associated with new mental health diagnoses following AMI-CS included female sex, pre-existing mental health diagnoses, and discharge to a long-term hospital or rehabilitation institute. Conclusion: Survivors of AMI-CS experience substantial mental health morbidity following discharge. Risk of new mental health diagnoses was comparable between survivors of AMI with and without shock. Future research on interventions to mitigate psychiatric sequelae after AMI-CS is warranted.
AB - Purpose: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge. Methods: We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18 years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019. We compared these patients to AMI survivors without shock. We captured outcome data using linked health administrative databases. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia/psychotic disorders; and other mental health disorders) following hospital discharge. We secondarily evaluated incidence of deliberate self-harm and death by suicide. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. Results: We included 7812 consecutive survivors of AMI-CS, from 135 centers. Mean age was 68.4 (standard deviation (SD) 12.2) years, and 70.3% were male. Median follow-up time was 767 days (interquartile range (IQR) 225–1682). Incidence of new mental health diagnosis among AMI-CS survivors was 109.6 per 1,000 person-years (95% confidence interval (CI) 105.4–113.9), compared with 103.8 per 1000 person-years (95% CI 102.5–105.2) among AMI survivors without shock. After propensity score adjustment, there was no difference in the risk of new mental health diagnoses following discharge [hazard ratio (HR) 0.99 (95% CI 0.94–1.03)]. Factors associated with new mental health diagnoses following AMI-CS included female sex, pre-existing mental health diagnoses, and discharge to a long-term hospital or rehabilitation institute. Conclusion: Survivors of AMI-CS experience substantial mental health morbidity following discharge. Risk of new mental health diagnoses was comparable between survivors of AMI with and without shock. Future research on interventions to mitigate psychiatric sequelae after AMI-CS is warranted.
KW - Cardiogenic shock
KW - Chronic critical illness
KW - Intensive care
KW - Mental health
KW - Myocardial infarction
KW - Post-intensive care syndrome
KW - Self-harm
KW - Suicide
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U2 - 10.1007/s00134-024-07399-3
DO - 10.1007/s00134-024-07399-3
M3 - Article
C2 - 38695924
AN - SCOPUS:85192025835
SN - 0342-4642
VL - 50
SP - 901
EP - 912
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 6
ER -