Am J Psychiatry 1994; 151:1637-1641
Copyright © 1994 by American Psychiatric Association
Cardiovascular morbidity in high-risk patients during ECT
EH Rice, LB Sombrotto, JC Markowitz and AC Leon
Department of Psychiatry, New York Hospital-Cornell Medical Center, Payne Whitney Psychiatric Clinic, New York, White Plains 10605.
OBJECTIVE: Cardiovascular events are the principal cause of medical
morbidity in patients receiving ECT. To assess the risks of ECT for
individuals with preexisting cardiovascular disease, the authors examined
medical complications in older patients treated with ECT during a 1-year
period. METHOD: A case-control design was used in a review of the charts of
80 consecutive patients who received ECT from August 1990 to August 1991.
On the basis of accepted clinical criteria, patients over 50 years of age
were divided into two groups: one at increased risk for cardiac
complications (N = 26) and one at standard cardiac risk (N = 27). Outcome
was measured with a scale designed to assess clinically relevant medical
complications. RESULTS: The risk group was older and had received more
medical consultations before ECT than the nonrisk group. Although patients
in the risk group were more likely to develop minor complications during
ECT, they did not differ significantly from the comparison group in the
rate of major complications. No patients died or sustained permanent
cardiac morbidity during ECT. CONCLUSIONS: In contrast to a similar study
at the same site 15 years earlier, the current study found ECT to be
relatively safe in an unselected study group of elderly patients with
preexisting cardiac risk factors. The findings underscore the advances in
ECT technique over the past 15 years and the importance of identifying and
carefully managing patients with cardiac risk factors before and during
ECT.
