Elsevier

General Hospital Psychiatry

Volume 25, Issue 4, July–August 2003, Pages 269-276
General Hospital Psychiatry

Commentary and perspective
Incidence and correlates of near-death experiences in a cardiac care unit

https://doi.org/10.1016/S0163-8343(03)00042-2Get rights and content

Abstract

Near-death experiences, unusual experiences during a close brush with death, may precipitate pervasive attitudinal and behavior changes. The incidence and psychological correlates of such experiences, and their association with proximity to death, are unclear. We conducted a 30-month survey to identify near-death experiences in a tertiary care center cardiac inpatient service. In a consecutive sample of 1595 patients admitted to the cardiac inpatient service (mean age 63 years, 61% male), of whom 7% were admitted with cardiac arrest, patients who described near-death experiences were matched with comparison patients on diagnosis, gender, and age. Near-death experiences were reported by 10% of patients with cardiac arrest and 1% of other cardiac patients (P<.001). Near-death experiencers were younger than other patients (P=.001), were more likely to have lost consciousness (P<.001) and to report prior purportedly paranormal experiences (P=.009), and had greater approach-oriented death acceptance (P=.01). Near-death experiencers and comparison patients did not differ in sociodemographic variables, social support, quality of life, acceptance of their illness, cognitive function, capacity for physical activities, degree of cardiac dysfunction, objective proximity to death, or coronary prognosis.

Introduction

Unusual experiences at the approach of death, which have come to be called near-death experiences in recent decades, have been reported anecdotally for centuries and described in medical journals since the 19th century [1]. These experiences, which often include subjective impressions of being outside the physical body and of seeing deceased relatives, are of importance to mental health professionals because they may be followed by pervasive changes in attitudes and behavior. Cassem and Hackett [2] a quarter century ago wrote that the incidence of near-death experiences was unknown, but estimated it at about 2% of survivors of cardiac arrest. Since that time, studies using objective measures among unbiased samples of patients coming close to death suggest an incidence of between 9% and 18% [1]. In the past year, a Dutch study of 344 consecutively admitted cardiac patients reported near-death experiences in 12% [3], a British study of 63 survivors of cardiac arrest reported near-death experiences in 11% [4], and an American study of 30 survivors of cardiac arrest reported near-death experiences in 23% [5].

This study investigated the incidence and correlates of near-death experiences among a large cohort of patients who came close to death from heart disease and were admitted to the cardiology service of the University of Virginia Health System. It was hypothesized that the incidence of near-death experience would be higher among patients with cardiac arrest than with those having other cardiac diagnoses.

Section snippets

Methods

Prospective subjects were all patients admitted to the cardiac intensive care unit (CCU) or the cardiology step-down unit of the University of Virginia Hospital who were not too ill, psychotic, or cognitively impaired to be interviewed. Patients were approached as soon after admission as their condition had stabilized, by study personnel who explained the project and invited them to participate.

Eligible patients who signed informed consent agreements to participate in the study were given a

Results

The mean age of the 1595 patients interviewed was 63 years ± 13; 970 patients (61%) were male. A total of 459 patients (29%) were employed, and 353 (22%) lived alone.

Of the 1595 patients, 675 (42%) were admitted to the cardiac intensive care unit (CCU); the rest were admitted directly to a step-down cardiac unit. Screening interviews were conducted in the CCU for 246 patients (15%) and on the step-down unit for the remaining patients. Screening interviews were conducted 3.8 ± 3.9 days after

Discussion

The findings of this study, the largest survey of near-death experiences among cardiac patients, confirm and extend findings of the three comparable but smaller studies published within the past year. A Dutch study [3] reported that 12% of cardiac patients described near-death experiences, and found no influence of unconsciousness, duration of arrest, or medication, although experiences were significantly associated with younger age. The latter finding was replicated in the present study. A

Acknowledgements

This study was supported by a research grant from the Institut für Grenzgebiete der Psychologie und Psychohygiene, Freiburg i. Br., Germany. I am indebted to Ian Stevenson, M.D., for his help in designing this research; and to Christina Fritz, R.N., Tiffany Pankow, M.D., and Jim B. Tucker, M.D., for their invaluable assistance in conducting patient interviews and evaluating medical records.

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