Key result
Electroconvulsive therapy was associated with low 30-day mortality (0.46% suicide, 0.61% medical causes), with older age and somatic comorbidities increasing the risk of medical death.
Why the study?
Electroconvulsive therapy reduces mortality in severe psychiatric disorders, but causes of death shortly after treatment and risk factors for medical mortality remained to be investigated.
Observational (n=20,225)
ECT is a low-risk procedure, but older patients with severe somatic diseases have a higher risk of 30-day medical mortality, primarily from cardiovascular disease, highlighting the need for optimized pre-ECT medical workup.
Medical mortality after ECT is low overall but rises with age and comorbidities; leaves open whether targeted pre-ECT optimization mitigates risks in high-risk subgroups.
BACKGROUND: Electroconvulsive therapy (ECT) is used to treat severe psychiatric disorders and is associated with reduced risk of suicide and all-cause mortality in patients with severe depression. We investigated the causes of death occurring shortly after ECT and identified potential risk factors for medical causes of death. METHODS: Patients treated with ECT between 2012 and 2018 were included in this Swedish register-based study. Multivariate binary logistic regression was used to calculate odds ratios for covariates to determine potential predictors of 30-day mortality. RESULTS: Of the 20,225 included patients, 93 (0.46 %) died of suicide and 123 (0.61 %) died of medical causes after ECT. Cardiovascular disease was the most common medical cause of death (n = 49, 40 %). An older age, a Charlson Comorbidity Index of 1 or more, atrial fibrillation, kidney disease, reflux disease, dementia, and cancer were associated with increased risk of death by medical causes. LIMITATIONS: Real-life observational studies based on registry data may demonstrate associations, but cannot determine causality. If medical records had been available, we would be better able to determine if deaths were due to the ECT, anesthesia, pre-existing medical conditions, or the mental disorder. CONCLUSIONS: ECT appears to be a low-risk medical procedure. Older individuals with severe somatic diseases have the highest risk of death and extra measures should be considered to optimize their medical health during the pre-ECT workup, and during and after ECT.
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Lindblad et al. (2022) conducted an observational in severe psychiatric disorders (n=20,225). Electroconvulsive therapy (ECT) was evaluated on 30-day mortality (medical causes and suicide). Electroconvulsive therapy was associated with low 30-day mortality (0.46% suicide, 0.61% medical causes), with older age and somatic comorbidities increasing the risk of medical death.
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