Mental health sequelae and management in survivors of cardiogenic shock: a nationwide population-based study

BACKGROUND: This study aimed to evaluate the incidence of new-onset mental disorders after cardiogenic shock (CS) and their association with long-term clinical outcomes, and to examine whether the use of psychiatric medications following diagnosis is associated with improved prognosis. METHODS: A nationwide population-based cohort study was performed using the Korean National Health Insurance Service database. All adult patients who were admitted to intensive care units (ICUs) for CS between January 2012 and December 2022 and survived hospital discharge were recruited. Patients with pre-existing psychiatric diagnoses were excluded, Finally, 112,297 patients were included in the current cohort. The primary analysis assessed the association between new-onset psychiatric disorders after hospital discharge and long-term clinical outcomes among survivors of CS, with the onset of newly developed mental disorders treated as a time-varying variable. Among patients diagnosed with a psychiatric disorder, a secondary analysis assessed the association between psychiatric medication use including antidepressants, antipsychotics, anxiolytics, or sedative-hypnotics and clinical outcomes. Medication use was also modeled as a time-varying covariate. The primary endpoint was a composite of all-cause death, myocardial infarction, stroke, coronary revascularization, or heart failure hospitalization. RESULTS: During the median follow-up of 3.5 years (interquartile range: 1.26–6.56), 11,166 CS survivors (9.9%) developed new-onset mental disorders (including depressive disorder, insomnia, anxiety disorder, and schizophrenia spectrum disorder). These disorders were associated with a significantly increased risk of primary endpoint (adjusted-HR:1.08, 95%CI:1.04–1.13), except anxiety disorders. Among patients with mental disorders, initiation of medication for mental disorders was associated with a 44% reduction in the primary endpoint (adjusted-HR:0.56, 95%CI:0.53–0.59) and a 49% reduction in all-cause death (adjusted-HR:0.51, 95%CI:0.48–0.55). CONCLUSIONS: New-onset mental disorders are common and prognostically significant in survivors of CS. Timely pharmacologic intervention for mental disorders may substantially improve long-term clinical outcomes and should be integrated into post-ICU care pathways.