ImportanceLarge-scale evidence for the efficacy of continuation and maintenance electroconvulsive therapy (c/mECT) is lacking.ObjectiveTo provide an exhaustive and naturalistic insight into the real-world outcomes and the cost-effectiveness of c/mECT in a large dataset.Design, Setting, and ParticipantsThis cohort study included all patients in the Danish National Patient Registry who initiated treatment with ECT from 2003 through 2022. The data were analyzed from October 2023 to February 2024.ExposuresECT. An algorithm to identify c/mECTs in the dataset was developed: (>3 treatments with ≥7 and <90 days between adjacent treatments, occurring within a time frame of 180 days [cECT] or more [mECT] after an acute [aECT] series).Main Outcomes and MeasuresThe association of c/mECT with subsequent 6- to 12-month risk of hospitalization or suicidal behavior using Cox proportional hazard regression with multiple adjustments and aECT only as a reference, propensity score matching, and self-controlled case series analysis using a Poisson regression model. A cost-effectiveness analysis based on hospitalization and ECT expenses was made.ResultsA total of 19 944 individuals were treated with ECT (12 157 women [61%], 7787 men [39%]; median [IQR] age, 55 [41-70] years). Of these, 1533 individuals (7.7%) received c/mECT at any time point (1017 [5.1%] cECT only and 516 [2.6%] mECT). Compared with patients receiving aECT only, c/mECT patients more frequently experienced schizophrenia (odds ratio [OR], 2.14; 95% CI, 1.86-2.46) and schizoaffective disorder (OR, 2.42; 95% CI, 1.90-3.09) and less frequently unipolar depression (OR, 0.56; 95% CI, 0.51-0.62). In all models, c/mECT was associated with a lower rate of hospitalization after finishing aECT (eg, 6-month adjusted hazard ratio, 0.68; 95% CI, 0.60-0.78 [Cox regression]; 6-month incidence rate ratio, 0.51; 95% CI, 0.41-0.62 [Poisson regression]). There was no significant difference in the risk of suicidal behavior. Compared with the periods before the end of aECT, c/mECT was associated with a substantial reduction in total treatment costs.Conclusions and RelevanceIn a nationwide and naturalistic setting, c/mECT after aECT was infrequently used but associated with a lower risk of readmission than aECT alone. The totality of the evidence indicates that c/mECT should be considered more often to prevent relapse after successful aECT in patients whose condition does not respond sufficiently to other interventions.

中文翻译：

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持续和维持电休克治疗的临床结局


重要性缺乏关于持续和维持电休克疗法 （c/mECT） 疗效的大规模证据。目的在大型数据集中对 c/mECT 的真实结果和成本效益提供详尽而自然的见解。设计、设置和参与者该队列研究包括 2003 年至 2022 年丹麦国家患者登记处开始接受 ECT 治疗的所有患者。数据是从 2023 年 10 月到 2024 年 2 月进行的分析。开发了一种识别数据集中 c/mECT 的算法：（>3 次 ≥7 和 < 治疗相邻治疗之间 90 天，发生在急性 [aECT] 系列后 180 天 [cECT] 或更长时间 [mECT] 的时间范围内）。主要结局和测量c/mECT 与随后 6 至 12 个月住院或自杀行为风险的关联，使用 Cox 比例风险回归，多重调整和 aECT 仅作为参考，倾向评分匹配，以及使用泊松回归模型的自我对照病例系列分析。根据住院和 ECT 费用进行了成本效益分析。结果共有 19 944 例个体接受了 ECT 治疗 （12 157 例女性 [61%]，7787 例男性 [39%];中位 [IQR] 年龄，55 [41-70] 岁）。其中，1533 人 （7.7%） 在任何时间点接受了 c/mECT （仅 1017 例 [5.1%] cECT 和 516 例 [2.6%] mECT）。与仅接受 aECT 的患者相比，c/mECT 患者更常出现精神分裂症 （比值比 [OR]，2.14;95% CI，1.86-2.46）和分裂情感障碍 （OR，2.42;95% CI，1.90-3.09） 和较少见的单相抑郁 （OR，0.56;95% CI，0.51-0.62）。 在所有模型中，c/mECT 与完成 aECT 后较低的住院率相关 （例如，6 个月调整风险比，0.68;95% CI，0.60-0.78 [Cox 回归];6 个月发病率比，0.51;95% CI，0.41-0.62 [泊松回归]）。自杀行为的风险没有显著差异。与 aECT 结束前相比，c/mECT 与总治疗费用的显着降低相关。结论和相关性在全国性和自然主义环境中，aECT 后的 c/mECT 不常使用，但与单独使用 aECT 相比，再入院风险更低。全部证据表明，对于病情对其他干预措施反应不足的患者，应更频繁地考虑 c/mECT，以防止 aECT 成功后复发。