Objective Patients with bipolar disorder and schizophrenia are at high cardiovascular risk; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared with the general population remains scarcely investigated. Methods We conducted a nested case-control study using Cox regression to assess the association of bipolar disorder and schizophrenia with the HRs of OHCA of presumed cardiac cause (2001–2015). Reported are the HRs with 95% CIs overall and in subgroups defined by established cardiac disease, cardiovascular risk factors and psychotropic drugs. Results We included 35 017 OHCA cases and 175 085 age-matched and sex-matched controls (median age 72 years and 66.9% male). Patients with bipolar disorder or schizophrenia had overall higher rates of OHCA compared with the general population: HR 2.74 (95% CI 2.41 to 3.13) and 4.49 (95% CI 4.00 to 5.10), respectively. The association persisted in patients with both cardiac disease and cardiovascular risk factors at baseline (bipolar disorder HR 2.14 (95% CI 1.72 to 2.66), schizophrenia 2.84 (95% CI 2.20 to 3.67)) and among patients without known risk factors (bipolar disorder HR 2.14 (95% CI 1.09 to 4.21), schizophrenia HR 5.16 (95% CI 3.17 to 8.39)). The results were confirmed in subanalyses only including OHCAs presenting with shockable rhythm or receiving an autopsy. Antipsychotics—but not antidepressants, lithium or antiepileptics (the last two only tested in bipolar disorder)—increased OHCA hazard compared with no use in both disorders. Conclusions Patients with bipolar disorder or schizophrenia have a higher rate of OHCA compared with the general population. Cardiac disease, cardiovascular risk factors and antipsychotics represent important underlying mechanisms. No data are available. The data, analytical methods and study materials cannot be made available to other researchers for purposes of reproducing the results or replicating the procedure.

中文翻译：

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双相情感障碍或精神分裂症患者院外心脏骤停的风险

目的双相情感障碍和精神分裂症患者心血管风险高；然而，与一般人群相比，院外心脏骤停 (OHCA) 的风险仍然很少被调查。方法 我们使用 Cox 回归进行了一项嵌套病例对照研究，以评估双相情感障碍和精神分裂症与 OHCA 推测的心脏原因的 HR 之间的关联（2001-2015）。报告的是具有 95% CI 的总体和由已确定的心脏病、心血管危险因素和精神药物定义的亚组中的 HR。结果 我们纳入了 35 017 名 OHCA 病例和 175 085 名年龄匹配和性别匹配的对照（中位年龄 72 岁和 66.9% 的男性）。与一般人群相比，双相情感障碍或精神分裂症患者的 OHCA 总体发生率更高：HR 2.74（95% CI 2.41 至 3.13）和 4.49（95% CI 4。00 到 5.10），分别。这种关联在基线时同时具有心脏病和心血管危险因素的患者（双相情感障碍 HR 2.14（95% CI 1.72 至 2.66）、精神分裂症 2.84（95% CI 2.20 至 3.67））和没有已知危险因素的患者（双相情感障碍）中持续存在HR 2.14（95% CI 1.09 至 4.21），精神分裂症 HR 5.16（95% CI 3.17 至 8.39））。结果在亚组分析中得到证实，仅包括出现可电击节律或接受尸检的 OHCA。抗精神病药——但不是抗抑郁药、锂盐或抗癫痫药（最后两种仅在双相情感障碍中进行测试）——与在两种疾病中均未使用相比，增加了 OHCA 风险。结论双相情感障碍或精神分裂症患者的OHCA发生率高于一般人群。心脏病，心血管危险因素和抗精神病药是重要的潜在机制。没有可用数据。不得将数据、分析方法和研究材料提供给其他研究人员，用于再现结果或重复程序。