Stress-related disorders and anxiety linked to higher risk of out-of-hospital cardiac arrest

Denmark: New study from Denmark found that there is an increased risk of out-of-hospital cardiac arrest (OHCA) in patients having stress-related disorders or anxiety. By comparing more than 35,000 OHCA case patients with a similar number of matched control persons researchers found an almost 1.5 times higher hazard of long-term stress conditions and anxiety among OHCA patients. The study results were published in the journal BMJ Open Heart. 

Cardiovascular disease is more likely to occur in patients with stress- and anxiety-related problems. However, there is little research done on the risk of out-of-hospital cardiac arrest. Hence researchers from Denmark conducted a study to determine if chronic stress (post-traumatic stress disorder, adjustment disorder) or anxiety is linked to OHCA in the general population. 

Researchers carried out a nested case–control study in a nationwide cohort of individuals between 1 June 2001 and 31 December 2015 in Denmark. OHCA patients with presumed cardiac causes were considered cases. Each case was matched by age, sex, and date of OHCA with 10 non-OHCA controls from the general population. Cox models were used to derive hazard ratios for OHCAs after controlling for common OHCA risk factors. Stratified analyses were performed according to sex, age, and pre-existing cardiovascular disease. 

Results:

• Researchers included 35,195 OHCAs and 3,51,950 matched controls with a median age of 72 years. There were more men than women (66.8% male).
• About 324 (0.92%) OHCA cases and 1577 (0.45%) non-OHCA controls were diagnosed with long-term stress conditions and were associated with higher rates of OHCA.
• Almost 299 (0.85%) OHCA cases and 1298 (0.37%) controls were diagnosed with anxiety and were associated with an increased rate of OHCA.
• There was no interaction with sex, age, or history of cardiovascular diseases.

"This study raises awareness of the higher risks of OHCA and early risk monitoring to prevent OHCA in patients with stress-related disorders and anxiety," write Talip Eroglu, of the Department of Cardiology, Copenhagen University Hospital, Denmark, and colleagues. 

Both men and women are equally affected by this connection, which is not related to the existence of cardiovascular disease. When treating individuals with stress-related illnesses and anxiety, it's crucial to be aware of the elevated risks of OHCA in these patients. Posttraumatic stress disorder (PTSD) was associated with an almost twofold higher risk of OHCA. 

Further reading: Eroglu TE, Coronel R, Halili A, et al. Long-term stress conditions and out-of-hospital cardiac arrest risk: a nested case-control study. Open Heart. 2023;10(1):e002223. doi:10.1136/openhrt-2022-002223