Adverse Cardiovascular Events After ECT: Reassuring New Registry Study From Sweden
Out on PubMed, from the Nordenskjolds, is this study:
Major adverse cardiovascular events following electroconvulsive therapy in depression: A register-based nationwide Swedish cohort study with 1-year follow-up.
Methods: This nationwide, registry-based cohort study included all patients admitted to Swedish hospitals due to moderate or severe unipolar depression between 2011 and 2018. Patients were divided into an ECT group and a non-ECT group, and followed for 1 year. Patients were matched by risk factors for cardiovascular disease by propensity score matching. Cox regression was used to examine the association between ECT and MACE.
Results: Out of a total of 28 584 inpatients, 5476 patients who had received ECT were matched to 5476 non-ECT patients. ECT was associated with reduced risk of MACE within 90 days and 1 year. Within 1 year after admission, a total of 127 patients (2.3%) in the non-ECT group and 82 patients (1.4%) in the ECT group had at least one MACE (hazard ratio [HR], 0.65; 95% confidence interval, 0.49-0.85).
Limitations: Real-life observational studies carry risk for residual confounding.
Conclusions: ECT in patients hospitalized for depression was not associated with any significant short-term risks of cardiovascular events. Instead, ECT was associated with a reduced risk of MACE within 1 year after admission compared with patients not treated with ECT. This association may be explained by reduced depressive symptoms after ECT, improved risk factor management in the ECT-group or by residual confounding by indication.
Keywords: Depression; cardiovascular disease; cohort study; electroconvulsive therapy; mortality.
This yet another excellent and important study from Sweden, based on registry data. It is well and clearly presented, with very careful note of possible limitations. The data are very reassuring about the medical safety of ECT. The high use of ECT, 22% of patients hospitalized with moderate or severe depression, is noteworthy.
The below comment is from the first author, Axel Nordenskjöld
ReplyDeleteIn my opinion, the most important results from this study is that it identifies patient groups with better results following ECT than alternative treatments (mainly medication). Experienced clinicians are already aware of this, but this study adds empirical evidence that we should prioritize ECT to those with psychotic symptoms, of older age, with more prior medication failures, and family history of severe affective disorder and suicide but be more careful about patients with comorbid substance abuse or personality disorders. It is important to make ECT available to those who are likely to benefit, and also to recommend other treatments to those who are unlikely to experience the desired results.
Axel Nordenskjöld