TY - JOUR
T1 - Electrocardiographic abnormalities as potential contributors to premature mortality in patients with mental illness in a psychiatric day treatment program
AU - Linzer, Mark
AU - Baker, Karen C.
AU - Poplau, Sara
AU - Coffey, Ellen
AU - Shroff, Gautam
AU - Baum, Inna
AU - Yoder, Patrick
AU - Clifford, Pamela
N1 - Funding Information:
Thanks are due to Ahmad Nasri for valuable comments on initial versions of this paper. This work was supported by a grant (2007-2008) from the Lebanese Council for Scientific Research.
PY - 2013
Y1 - 2013
N2 - Objective: Because patients with mental illness can die prematurely, we sought to determine if undetected cardiovascular disease might be present in a psychiatric day treatment population. Method: We studied 96 patients in a day treatment program seen between February 2011 and August 2012. Data were obtained through an electronic medical record database. Electrocardiographic diagnoses were assigned by 1 investigator (M.L.). Medications were categorized into classes, and problem lists revealed comorbid diagnoses. Fisher exact test (2-tailed) and analysis of variance were used to compare findings between patient groups. Electrocardiogram (ECG) findings were the primary outcome measure. Results: Ninety-two ECGs were performed in 37 patients. Of these 37 patients, 70% were women, 65% were 50 years of age or younger, and 54% were people of color. ECGs were performed mainly for chest pain/dyspnea (46%) and overdose/altered mental status (27%). Of these 37 patients, 20 (54%) had abnormal ECGs, 7 (19%) had borderline findings, and 10 (27%) had normal studies. When compared with the larger group of 59 patients without ECG testing, those with abnormal ECGs were more likely to be older (mean age = 47 vs 37 years, P <.001) and have more comorbid conditions (mean no. = 10.0 vs 3.8, P <.0001). The most common abnormalities were conduction disorders (prolonged QRS ≥ 105 ms, or prolonged QTc ≥ 450 ms in men or ≥ 460 ms in women), coronary artery disease, and arrhythmias. Conclusions: In psychiatric outpatients who underwent ECG testing, mainly for chest pain or altered mental status, over 50% had concerning findings. Older patients with multiple comorbidities were at higher risk of having abnormal ECGs. Generalizability of these findings depends on validation in larger samples in multiple settings.
AB - Objective: Because patients with mental illness can die prematurely, we sought to determine if undetected cardiovascular disease might be present in a psychiatric day treatment population. Method: We studied 96 patients in a day treatment program seen between February 2011 and August 2012. Data were obtained through an electronic medical record database. Electrocardiographic diagnoses were assigned by 1 investigator (M.L.). Medications were categorized into classes, and problem lists revealed comorbid diagnoses. Fisher exact test (2-tailed) and analysis of variance were used to compare findings between patient groups. Electrocardiogram (ECG) findings were the primary outcome measure. Results: Ninety-two ECGs were performed in 37 patients. Of these 37 patients, 70% were women, 65% were 50 years of age or younger, and 54% were people of color. ECGs were performed mainly for chest pain/dyspnea (46%) and overdose/altered mental status (27%). Of these 37 patients, 20 (54%) had abnormal ECGs, 7 (19%) had borderline findings, and 10 (27%) had normal studies. When compared with the larger group of 59 patients without ECG testing, those with abnormal ECGs were more likely to be older (mean age = 47 vs 37 years, P <.001) and have more comorbid conditions (mean no. = 10.0 vs 3.8, P <.0001). The most common abnormalities were conduction disorders (prolonged QRS ≥ 105 ms, or prolonged QTc ≥ 450 ms in men or ≥ 460 ms in women), coronary artery disease, and arrhythmias. Conclusions: In psychiatric outpatients who underwent ECG testing, mainly for chest pain or altered mental status, over 50% had concerning findings. Older patients with multiple comorbidities were at higher risk of having abnormal ECGs. Generalizability of these findings depends on validation in larger samples in multiple settings.
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U2 - 10.4088/PCC.12m01484
DO - 10.4088/PCC.12m01484
M3 - Article
C2 - 24171146
AN - SCOPUS:84880619128
SN - 1523-5998
VL - 15
JO - Primary Care Companion to the Journal of Clinical Psychiatry
JF - Primary Care Companion to the Journal of Clinical Psychiatry
IS - 3
ER -