Age effect of antipsychotic medications on the risk of sudden cardiac death in patients with schizophrenia: A nationwide case–crossover study

Pao Huan Chen, Shang Ying Tsai, Chun Hung Pan, Chi Kang Chang, Sheng Shiang Su, Chiao Chicy Chen, Chian Jue Kuo

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)594-601
Number of pages8
JournalPsychiatry and Clinical Neurosciences
Volume74
Issue number11
DOIs
Publication statusPublished - Nov 1 2020

Keywords

  • age effect
  • antipsychotics
  • case–crossover
  • schizophrenia
  • sudden cardiac death

ASJC Scopus subject areas

  • Neuroscience(all)
  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health

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