In a recently published study in the Journals of the American College of Cardiology Clinical Electrophysiology, researchers aimed to ascertain the characteristics of increased SCD in individuals with schizophrenia.

In the study, researchers examined data from the End Unexplained Cardiac Death prospective state-wide registry in Australia and compared individuals aged younger than 50 years diagnosed with schizophrenia with individuals without schizophrenia who experienced SCD within a 2-year period and were referred for forensic examination.

The study involved 579 cases, of whom 65 individuals (11.2%) had schizophrenia. Data for the study were obtained from cases referred for evaluation by forensic services between April 2019 and April 2021. The researchers also evaluated the medication histories of the patients and postmortem toxicology reports to find individuals who used QTc-prolonging medications (QTc is the heart rate–corrected QT interval; this measures the time required to reset the heart’s electric system).

The results revealed that patients with schizophrenia compared with those without schizophrenia were more likely to smoke (46.2% vs. 23.0%) and use QTc-prolonging medications (69.2% vs. 17.9%), respectively. Additionally, those with schizophrenia were less prone to arrest while exercising (0.0% vs. 6.4%; P = .04) compared with those without schizophrenia. Other unfavorable arrest-related factors included lower rates of witnessed arrest (6.2% vs. 23.5%; P <.0001), more likely to be found in asystole (92.3% vs. 73.3%; P <.0001), and being more likely to be found deceased as part of a welfare check after a prolonged period (average 42 hours vs. 12 hours; P = .003). Other results revealed that there was more frequent evidence of decomposition, and an autopsy was more likely to be performed (41.2% vs. 26.4%; P = .04 and 93.8% vs. 82.5%; P = .05), with a diagnosis of nonischemic cardiomyopathy being more frequent (29.2% vs. 18.1%; P = .04).

Based on their findings, the researchers concluded that individuals with schizophrenia accounted for 11% of younger SCD patients referred for forensic investigations, surpassing population rates by 11-fold. They also noted that factors related to social isolation were often common in patients with schizophrenia with documented SCD.

The authors wrote, “This study is the first to explore the impact of biopsychosocial factors such as social isolation on the association of schizophrenia and cardiac arrest specifically, but our findings suggest that these are a critical part of the puzzle.”

The authors concluded, “They have a higher preexisting cardiac risk factor burden, unfavorable resuscitation profiles, and higher rates of nonischemic cardiomyopathy. Strategies targeting biopsychosocial support may deliver not only psychological benefits but also help to decrease unwitnessed cardiac arrest.”

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