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Electrocardiographic Abnormalities as Potential Contributors to Premature Mortality in Patients With Mental Illness in a Psychiatric Day Treatment Program

Mark Linzer, MD; Karen C. Baker, MPH; Sara Poplau, BA; Ellen Coffey, MD; Gautam Shroff, MD; Inna Baum, BA; Patrick Yoder, PharmD; and Pamela Clifford, RN, MPH

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ABSTRACT

Objective: Because patients with mental illness can die prematurely, we sought to determine if undetected cardiovascular disease might be present in a psychiatric day treatment population.

Method: We studied 96 patients in a day treatment program seen between February 2011 and August 2012. Data were obtained through an electronic medical record database. Electrocardiographic diagnoses were assigned by 1 investigator (M.L.). Medications were categorized into classes, and problem lists revealed comorbid diagnoses. Fisher exact test (2-tailed) and analysis of variance were used to compare findings between patient groups. Electrocardiogram (ECG) findings were the primary outcome measure.

Results: Ninety-two ECGs were performed in 37 patients. Of these 37 patients, 70% were women, 65% were 50 years of age or younger, and 54% were people of color. ECGs were performed mainly for chest pain/dyspnea (46%) and overdose/altered mental status (27%). Of these 37 patients, 20 (54%) had abnormal ECGs, 7 (19%) had borderline findings, and 10 (27%) had normal studies. When compared with the larger group of 59 patients without ECG testing, those with abnormal ECGs were more likely to be older (mean age = 47 vs 37 years, P < .001) and have more comorbid conditions (mean no. = 10.0 vs 3.8, P < .0001). The most common abnormalities were conduction disorders (prolonged QRS 105 ms, or prolonged QTc 450 ms in men or 460 ms in women), coronary artery disease, and arrhythmias.

Conclusions: In psychiatric outpatients who underwent ECG testing, mainly for chest pain or altered mental status, over 50% had concerning findings. Older patients with multiple comorbidities were at higher risk of having abnormal ECGs. Generalizability of these findings depends on validation in larger samples in multiple settings.

Prim Care Companion CNS Disord 2013;15(3):doi:10.4088/PCC.12m01484

Submitted: October 22, 2012; accepted February 18, 2013.

Published online: May 9, 2013.

Corresponding author: Mark Linzer, MD, Division of General Internal Medicine, Hennepin County Medical Center (HCMC), 701 Park Ave (P7), Minneapolis, MN 55415 (mark.linzer@hcmed.org).