title: Sudden cardiac death in young adults with previous hospital-based psychiatric inpatient and outpatient treatment: a nationwide cohort study from Denmark.
abstract: BACKGROUND
  Psychiatric patients have premature mortality compared to the general population. The incidence of sudden cardiac death (SCD) in psychiatric patients is unknown in a nationwide setting. The aim of this study was to compare nationwide SCD incidence rates in young individuals with and without previous psychiatric disease.
  
  
  METHODS
  Nationwide, retrospective cohort study including all deaths in people aged 18-35 years in 2000-2006 in Denmark. The unique Danish death certificates and autopsy reports were used to identify SCD cases. Psychiatric disease was defined as a previous psychiatric hospital contact and was identified using The Danish Psychiatric Central Research Register. All diagnoses in Danish registries are coded according to ICD-8 or ICD-10. All hospital records were retrieved manually.
  
  
  RESULTS
  Among 5,178 deaths, 395 were due to SCD and autopsies were performed on 262 (66%). In 77 SCD cases, a previous psychiatric hospital contact was identified. The SCD incidence rate in psychiatric patients was 14.8 (95% CI, 11.7-18.5) per 100,000 person-years versus 3.8 (95% CI, 3.4-4.3) per 100,000 person-years in individuals without psychiatric hospital contact (incidence rate ratio = 3.9; 95% CI, 3.0-5.0; P < .01). Incidence rates per 100,000 persons-years were the highest in patients with schizophrenia-spectrum disorders (38.9; 95% CI, 26.4-55.2) and substance-related disorders (31.6; 95% CI, 19.3-48.8). SCDs in psychiatric patients compared to nonpsychiatric patients were more often unexplained (65% vs 40%, P = .02), and cardiac symptoms were reported prior to death in 46% of psychiatric patients.
  
  
  CONCLUSIONS
  Patients with prior psychiatric hospital contact have a 4-fold increased risk of SCD. Since almost 50% had possible cardiac symptoms prior to death, cardiovascular risk monitoring and management in the mentally ill are essential.
authors.affiliation: Laboratory of Molecular Cardiology, afsnit 9312, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark bjarkerisgaard@gmail.com.
authors.forename: Bjarke
authors.initials: B
authors.lastname: Risgaard
authors.forename: Kristine
authors.initials: K
authors.lastname: Waagstein
authors.forename: Bo Gregers
authors.initials: BG
authors.lastname: Winkel
authors.forename: Reza
authors.initials: R
authors.lastname: Jabbari
authors.forename: Thomas Hadberg
authors.initials: TH
authors.lastname: Lynge
authors.forename: Charlotte
authors.initials: C
authors.lastname: Glinge
authors.forename: Christine
authors.initials: C
authors.lastname: Albert
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.forename: Stig
authors.initials: S
authors.lastname: Haunsø
authors.forename: Anders
authors.initials: A
authors.lastname: Fink-Jensen
authors.forename: Jacob
authors.initials: J
authors.lastname: Tfelt-Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult