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Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study

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Abstract

Purpose

Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge.

Methods

We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18 years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019. We compared these patients to AMI survivors without shock. We captured outcome data using linked health administrative databases. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia/psychotic disorders; and other mental health disorders) following hospital discharge. We secondarily evaluated incidence of deliberate self-harm and death by suicide. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models.

Results

We included 7812 consecutive survivors of AMI-CS, from 135 centers. Mean age was 68.4 (standard deviation (SD) 12.2) years, and 70.3% were male. Median follow-up time was 767 days (interquartile range (IQR) 225–1682). Incidence of new mental health diagnosis among AMI-CS survivors was 109.6 per 1,000 person-years (95% confidence interval (CI) 105.4–113.9), compared with 103.8 per 1000 person-years (95% CI 102.5–105.2) among AMI survivors without shock. After propensity score adjustment, there was no difference in the risk of new mental health diagnoses following discharge [hazard ratio (HR) 0.99 (95% CI 0.94–1.03)]. Factors associated with new mental health diagnoses following AMI-CS included female sex, pre-existing mental health diagnoses, and discharge to a long-term hospital or rehabilitation institute.

Conclusion

Survivors of AMI-CS experience substantial mental health morbidity following discharge. Risk of new mental health diagnoses was comparable between survivors of AMI with and without shock. Future research on interventions to mitigate psychiatric sequelae after AMI-CS is warranted.

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Funding

Funded by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). ICES is an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOH is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). This study also used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from Canada Post Corporation and Statistics Canada.

Author information

Author notes

  1. Peter Tanuseputro and Rebecca Mathew contributed equally.

Authors and Affiliations

  1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Shannon M. Fernando, Pietro Di Santo & Kwadwo Kyeremanteng

  2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Shannon M. Fernando, Robert Talarico, Daniel I. McIsaac, Kwadwo Kyeremanteng & Peter Tanuseputro

  3. Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada

    Shannon M. Fernando

  4. Nuffield Department of Population Health, University of Oxford, Oxford, UK

    Danial Qureshi

  5. ICES, Toronto, ON, Canada

    Danial Qureshi, Robert Talarico, Simone N. Vigod, Daniel I. McIsaac, Damon C. Scales & Peter Tanuseputro

  6. Bruyère Research Institute, Ottawa, ON, Canada

    Danial Qureshi & Peter Tanuseputro

  7. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Simone N. Vigod

  8. Women’s College Hospital and Research Institute, Toronto, ON, Canada

    Simone N. Vigod

  9. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Simone N. Vigod, Eddy Fan, Damon C. Scales & Margaret S. Herridge

  10. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Daniel I. McIsaac, Pietro Di Santo & Peter Tanuseputro

  11. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada

    Daniel I. McIsaac

  12. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Lee H. Sterling, Pietro Di Santo & Rebecca Mathew

  13. Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada

    Sean van Diepen

  14. Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Sean van Diepen

  15. VIGOUR Centre, University of Alberta, Edmonton, AB, Canada

    Sean van Diepen

  16. Royal, Brompton & Harefield Hospitals, London, UK

    Susanna Price

  17. National Heart and Lung Institute, Imperial College, London, UK

    Susanna Price

  18. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Eddy Fan, Arthur S. Slutsky, Damon C. Scales & Margaret S. Herridge

  19. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Dale M. Needham & Daniel Brodie

  20. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Dale M. Needham

  21. Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Oscar Joseph Bienvenu

  22. Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France

    Alain Combes

  23. Service de Médeceine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France

    Alain Combes

  24. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Arthur S. Slutsky & Damon C. Scales

  25. Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany

    Holger Thiele

  26. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Benjamin Hibbert

  27. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Peter Tanuseputro

Authors
  1. Shannon M. Fernando
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  2. Danial Qureshi
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Corresponding author

Correspondence to Shannon M. Fernando.

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Role of funder/sponsor

Neither the Academic Health Sciences Centres of Ontario, ICES, nor CIHI had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Access to data and data analysis

SMF, RT and PT had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. See electronic supplement for details on access to data.

Conflicts of interest

SMF, DQ, RT, SNV, LHS, SvD, SP, PDS, OJB, DCS, MSH, HT, BH and RM have no conflicts to report. DIMcI is supported by a Clinical Research Chair at the University of Ottawa, The Ottawa Hospital Anesthesia Alternate Funds Association, and a Mid-Career Knowledge Translation award from Physician Services Inc. KK reports receiving personal fees from Edwards Life Sciences, outside of the submitted work. EF reports receiving personal fees from ALung Technologies, Aerogen, Baxter, Boehringer-Ingelheim, GE Healthcare, Inspira, and Vasomune, outside of the submitted work. DMN reports financial or in-kind support for consultancy or research from Baxter Healthcare Corporation, and Reck Medical Devices, outside of the submitted work. DB receives research support from and consults for LivaNova. He has been on the medical advisory boards for Xenios, Medtronic, Inspira and Cellenkos. AC reports receiving personal fees from Getinge, Baxter, and Xenios, outside of the submitted work. ASS reports consulting for Baxter International Inc. and Xenios. PT is supported by a Physician Services Incorporated Graham Farquharson Knowledge Translation Fellowship.

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Fernando, S.M., Qureshi, D., Talarico, R. et al. Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study. Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07399-3

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