Association of recent major psychological stress with cardiac arrest: A case-control study

Abstract Objective We hypothesized that major psychological stress can be a risk factor for cardiac arrest and that effects are modified by elapsed time from specific stressful events. Methods Case-control study was conducted using database for cardiac arrest and emergency department (ED) visiting. Cases included adult patients with cardiac arrest with presumed cardiac etiology. Controls were matched with sex and age and visiting day from unintentional injured patients in same ED. The occurrence of 9 major life events (MLEs) such as a divorce within 1 year was used as a proxy measure of major psychological stress. A multivariable conditional logistic regression conducted to estimate the effect of MLEs on the risk of cardiac arrest according to the elapsed time from the MLEs. Results A total of 95 patients with cardiac arrest and 95 controls were assessed. In the case group, a total of 58 MLEs occurred, while 33 MLEs occurred in the control group during the same period. Recent MLEs were associated with a higher risk of sudden cardiac arrest (AOR 2.26 [95% CI:1.01–5.03]). The AORs of cardiac arrest were 4.65 (95% CI, 1.38–15.67) and 7.02 (95% CI, 2.03–24.48) among participants experiencing MLEs within the last 0–3 months and those experiencing MLEs within the last 0–6 months, respectively. Cardiac arrest and MLEs in participants experiencing MLEs between 7 and 12 months prior showed no association (AOR 4.76 [95% CI, 0.97–18.36]). Conclusions MLEs were associated with cardiac arrest occurrence, and the effect was modified by the elapsed time from the MLEs.