Key result
Antipsychotics linked to age-variable sudden cardiac death, with zotepine increasing risk ~168% under age 45.
Why the study?
Research regarding the effects of age on sudden cardiac death risk among patients with schizophrenia taking antipsychotics was lacking.
Does exposure to antipsychotic medications increase the risk of sudden cardiac death in patients with schizophrenia across different age groups?
Case-Control (n=1,836)
Yes
Does exposure to antipsychotic medications increase the risk of sudden cardiac death in patients with schizophrenia across different age groups?
Individual antipsychotics pose different risks of sudden cardiac death in patients with schizophrenia across their lifespan, highlighting the need to consider patient age when evaluating treatment risks.
Answers are grounded in this paper and cite their sources.
May warrant age-specific antipsychotic caution in schizophrenia; leaves open need for prospective validation of risk mitigation.
AIM: Research regarding the effects of age in patients with schizophrenia taking antipsychotics on the risk of sudden cardiac death is lacking. We determined the effect of patient age on the association between exposure to antipsychotics and the risk of sudden cardiac death in a nationwide schizophrenia cohort. METHODS: From the Taiwan National Health Insurance Research Database and Department of Health Death Certification System, data of 1836 patients with schizophrenia who had experienced sudden cardiac death between 2000 and 2016 were included. A case-crossover design by using a 14-day window was applied, and subgroup analyses were performed by stratifying patients into three age subgroups (<45, 45-65, and >65 years) to assess the effect of age on the risk of sudden cardiac death in patients taking antipsychotics. RESULTS: No association between exposure to antipsychotic agents and sudden cardiac death risk was found in patients aged >65 years who were characterized by a high burden of medical illnesses. However, zotepine significantly increased the risk of sudden cardiac death in patients aged <45 years (adjusted relative risk [RR] = 2.68, P = 0.046). Flupentixol (adjusted RR = 5.30, P = 0.004) and risperidone (adjusted RR = 1.68, P = 0.01) significantly elevated the risk of sudden cardiac death in patients aged 45-65 years. CONCLUSION: This study suggests that individual antipsychotics pose different risks of sudden cardiac death in patients with schizophrenia across their lifespan. Clinicians should consider patient age when evaluating the risks and benefits of antipsychotic treatment.
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Chen et al. (2020) conducted a case-control in Schizophrenia (n=1,836). Antipsychotic medications vs. Non-exposure periods was evaluated on Sudden cardiac death (RR 2.68, p=0.046). Antipsychotic exposure increased sudden cardiac death risk variably by age, with zotepine elevating risk in patients <45 years and flupentixol in those 45-65 years.
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