Pazienti con arresto cardiaco e comorbilità psichiatrica: un'analisi del registro Pavia CARE

Background: psychiatric patients show consistently higher mortality rates compared to the general population, with more than ten years of potential life lost. Several factors may contribute to explain this shorter life expectancy in the psychiatric population and, a part from suicide, physical comorbidities may held responsible of this mortality gap between patients and controls. Among physical conditions, cardiac sudden death is considered one of the main causes of premature mortality in psychiatric illnesses. The causes of the high prevalence of cardiac sudden death in psychiatric patients may rely in high rate of cardiovascular risk factors in this population such as unhealthy lifestyle habits (i.e. smoking, physical inactivity or poor diet) as well as in cardiac toxicity produced by psychotropic medications (i.e antipsychotics which may determine QT prolongation). Objectives: We aimed to evaluate the prevalence of psychiatric patients among a registry for cardiac arrest and to identify potential characteristics of this patient group. Methods: 2000 out-of-hospital cardiac arrest medical records occurred in the Province of Pavia between October 2014 and March 2017 were retrospectively reviewed. Results: 85 records were incomplete and excluded from the analysis. Prevalence of psychiatric patients (in charge in outpatient psychiatric services in the Province of Pavia) was 10.6%. Cause of death was drug/medication overdose in 3% of patients. Possible suicide was the principal cause of death in 8% of the sample. Psychiatric patients having a cardiac arrest were mostly males (57%) and middle-aged. Conclusions: Our data are in line with findings from the Danish Cardiac Arrest Registry which observed similar rate of psychiatric patients. Of note, possible suicide as main cause of death was low compared to previous studies.