Vascular risk factors in maintenance versus acute electroconvulsive therapy: A retrospective case-control study from a regional Australian service

Objectives To compare vascular risk factors among patients receiving maintenance electroconvulsive therapy (M-ECT) versus acute ECT, and to examine cognitive outcomes associated with M-ECT. Methods A retrospective, single-centre, matched case-control study was conducted using a regional Health Service ECT Register (2015–2023). Adults with DSM-5 mood disorders were included. 25 received ≥6 months of M-ECT and 37 received acute-only ECT. Frequency matching achieved similar age structure and sex distribution. Vascular risk factors (hypertension, dyslipidaemia, diabetes, stroke, myocardial infarction, smoking) and a composite “high vascular risk” score (≥2 factors) were compared using Fisher’s exact tests and logistic regression. Cognition was assessed with the Montreal Cognitive Assessment (MoCA) at baseline and longitudinally with linear mixed-effects models. Results High vascular risk was common in both groups (M-ECT 76%; acute-only 68%) without significant between-group difference, although dyslipidaemia was more prevalent in the M-ECT group (OR 5.52, 95% CI: 1.51–20.20; p = 0.049). Baseline MoCA was comparable (21.9 vs 22.1) and remained stable during M-ECT (mean change +0.92; 95% CI: −0.51 to +2.35). High vascular risk, not ECT group, predicted cognition (−4.64, 95% CI: −7.45 to −2.01; p = 0.002). Conclusions Cognitive performance remained stable during M-ECT. Lower scores were associated with vascular comorbidity, and the higher dyslipidaemia rate underscores the need for cardiometabolic and cognitive monitoring.