Psychotropic Medication Associated With Higher Mortality in Cardiac Patients

Pernille Fevejle Cromhout

The heightening prevalence of mental disorders in cardiac patients have shown associations with a worsening prognosis for patients, as the subsequent use of psychotropic medication has been found to increase the risk of mortality.

As a result, a recent study published by the European Society of Cardiology explored the association between the use of psychotropic medication and mortality in cardiac patients with and without self-reported symptoms of anxiety.

Led by Pernille Fevejle Cromhout, Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, investigators observed the use of psychotropic medication prior to hospital admission was associated with a higher risk of 1-year, all-cause mortality, regardless of self-reported symptoms.

Methods

The study was based on the combination of self-reported data from the DenHeart national survey and data from the Danish national registers. All patients aged ≥18 years old discharged from 1 of 5 national heart centers in Denmark were then invited to fill out a questionnaire from April 2013 - April 2014.

The present analyses included patients with ischemic heart disease, arrhythmias, heart failure, and valvular heart disease. Individual information regarding prescriptions for psychotropic medication 6 months prior to hospitalization and post-discharge was obtained from the Danish National Prescription Registry (DNPR). Additionally, data on comorbidities covering a period of 10 years were available from the DNPR.

The study used the Hospital Anxiety and Depression Scale (HADS), a 14-item questionnaire that assessed symptoms of depression and anxiety in hospitalized patients admitted to non-psychiatric hospital clinics. A score of ≥8 suggested the presence of a disorder with anxiety or depression.

In logistic regression analyses, investigators estimated the association between the use of psychotropic medication 6 months prior to admission, self-reported symptoms of anxiety, and all-cause mortality within 1-year. In addition, the risk of subsequent incident use of psychotropic medications was explored by investigators.

Findings

The study included a total of 12,913 cardiac disease patients, of which 2335 (18%) redeemed ≥1 prescription for psychotropic medication during the 6 months prior to hospital admission and 362 (3%) died within the first year following hospitalization.

Data show a higher use of psychotropic medication in females, older patients, smokers, widowers, lower educated patients, and those with more comorbidities. In patients with symptoms of anxiety (n = 4085, 32%), 1133 (28%) used psychotropic medications, compared to 1202 (14%) among patients without symptoms of anxiety (P <.0001).

Further, 130 (6%) of the 2335 users of psychotropic medication in the 6 months prior to admission died within 1-year post-discharge. In comparison, 232 (2%) of non-users died in the same time period (P <.0001).

Investigators observed the use of psychotropic medication was associated with increased 1-year all cause mortality (odds ratio 1.90; 95% CI, 1.46 - 2.46). Additionally, patients with symptoms of anxiety were significantly more likely to redeem a prescription for any psychotropic medication in the 1-year after hospital discharge (2.47, 2.25 - 2.72).

Takeaways

“Thus, the use of psychotropic medication might explain some of the association between anxiety and mortality; however, the association is probably mainly a reflection of the underlying mental illness, rather than the use of psychotropic medication,” investigators wrote.

The study, “Exploring the use of psychotropic medication in cardiac patients with and without anxiety and its association with 1-year mortality,” was published in the European Journal of Cardiovascular Nursing.