Acute Somatic Events and Death Following ECT: New Danish Register Cohort Study
Out on PubMed, from researchers in Denmark, is this study:
Mortality and acute somatic events following electroconvulsive therapy in patients with preexisting somatic comorbidity - a register-based nationwide Danish cohort study.
Objective: To examine whether electroconvulsive therapy (ECT) is associated with risk of mortality and acute somatic events in patients with or without somatic comorbidity.
Methods: 174,495 patients with an affective disorder, of whom 41% had somatic comorbidity, were followed from 2005 through 2018 for ECT, mortality, and acute somatic outcomes using Danish registers. The association of ECT with outcomes was estimated using Cox proportional hazard regression.
Results: Patients, of whom 6,943 (4.0%) had ECT, were followed for a median of 6.7 years. Compared to non-ECT treated patients, ECT was associated with a lower risk of death from natural causes, which was independent of somatic comorbidity. ECT was not associated with the risk of acute somatic events neither in patients with nor without somatic comorbidity, except for cardiac events within 0-30 days of follow-up after the first ECT, for which there was a 3.7-fold higher risk in patients with no somatic comorbidity. This analysis, however, was based on few events.
Conclusion: In modern clinical practice, in patients with affective disorders and somatic comorbidity, ECT is not associated with a higher risk of death from natural causes or acute somatic events.
Keywords: acute somatic events; affective disorders; comorbidity; electroconvulsive therapy (ECT); mortality.
The pdf is here.
And from the text:
We investigated the influence of preexisting somatic comorbidity on mortality risk and the risk of
serious acute somatic events following ECT in a large cohort of patients with affective disorders.
Using Danish registries with nearly complete individual-level data on natural causes of death,
somatic disorders, and medication use, we were able to study individuals retrospectively from the
affective disorder diagnosis for somatic comorbidity and prospectively for up to more than a decade
after ECT for mortality and serious acute somatic events. We further compared these data with a
large reference group of non-ECT treated patients with affective disorders from the same cohort,
some of whom also had somatic comorbidity. This seems, to date, to be the only study that has
applied such a design, which is relevant because of the generally higher mortality in patients with
severe psychiatric disorders and due to the inherent somatic risks of psychopharmacological treatment.
...Based on this nationwide cohort study of patients with affective disorders, we conclude that ECT is
not associated with any short- or long-term higher mortality risk in patients with preexisting
somatic comorbidity. Likewise, ECT was not associated with any short- or long-term risk of
developing serious acute somatic events, except for a possible higher rate of non-mortal cardiac
events in ECT-treated patients without preexisting somatic comorbidity. The study contributes
substantially to our knowledge base on the safety of ECT in people with medical illness and
underlines the continuing importance of ECT as a safe treatment modality in patients with severe
affective disorders.
Here is another large epidemiological study from registry data in Denmark showing the medical safety of ECT, with short- and long-term follow up. 4% is actually a high rate of use of ECT in this population of patients with affective disorder.
The study is very clearly presented and the paper well written. These data are reassuring and quite compelling.
I recommend a full and careful read of this paper to all healthcare personnel involved in ECT, ~20 minutes.
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