alexa Antipsychotics and the Risks of Sudden Cardiac Death and All-Cause Death: Cohort Studies in Medicaid and Dually-Eligible Medicaid-Medicare Beneficiaries of Five States | Abstract
ISSN: 2155-9880

Journal of Clinical & Experimental Cardiology
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Research Article

Antipsychotics and the Risks of Sudden Cardiac Death and All-Cause Death: Cohort Studies in Medicaid and Dually-Eligible Medicaid-Medicare Beneficiaries of Five States

Charles E Leonard1,2*, Cristin P Freeman1,2, Craig W Newcomb1, Warren B Bilker1,2,3, Stephen E Kimmel1,2,4, Brian L Strom1,2,5,6 and Sean Hennessy1,2,6
1Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
2Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
3Division of Neuropsychiatry, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
4Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
5Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
6Department of Pharmacology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Corresponding Author : Charles E. Leonard
Center for Clinical Epidemiology and Biostatistics
Department of Biostatistics and Epidemiology
Perelman School of Medicine at the University of Pennsylvania
834 Blockley Hall / 423 Guardian Drive
Philadelphia, Pennsylvania 19104, USA
Tel: 1-215-573-2663
Fax: 1-215- 573-5315
E-mail: [email protected]
Received: March 21, 2013; Accepted: May 10, 2013; Published: May 12, 2013
Citation: Leonard CE, Freeman CP, Newcomb CW, Bilker WB, Kimmel SE, et al. (2013) Antipsychotics and the Risks of Sudden Cardiac Death and All-Cause Death: Cohort Studies in Medicaid and Dually Eligible Medicaid-Medicare Beneficiaries of Five States. J Clinic Experiment Cardiol S10:006. doi:10.4172/2155-9880.S10-006
Copyright: © 2013 Leonard CE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Context: Antipsychotic drugs have been linked to QT-interval prolongation, a presumed marker of cardiac risk, and torsade de pointes.

Objective: To examine the associations between antipsychotics and 1) outpatient-originated sudden cardiac death and ventricular arrhythmia (SD/VA) and 2) all-cause death.

Design: Two retrospective cohort studies

Setting: Medicaid programs of California, Florida, New York, Ohio and Pennsylvania.

Patients: Incident antipsychotic users aged 30-75 years.

Main Outcome Measures: 1) Incident, first-listed emergency department or principal inpatient SD/VA diagnoses; and 2) death reported in the Social Security Administration Death Master File.

Results: Among 459,614 incident antipsychotic users, the incidences of SD/VA and death were 3.4 and 35.1 per 1,000 person-years, respectively. Compared to olanzapine as the referent, adjusted hazard ratios (HRs) for SD/VA were 2.06 (95% CI, 1.20-3.53) for chlorpromazine, 1.72 (1.28-2.31) for haloperidol, and 0.73 (0.57-0.93) for quetiapine. Adjusted HRs for perphenazine and risperidone were consistent with unity. In a subanalysis limited to first prescription exposures, HRs for chlorpromazine and haloperidol were further elevated (2.54 [1.07-5.99] and 2.68 (1.59-4.53), respectively), with the latter exhibiting a dose-response relationship. Results for death were similar.

Conclusions: Haloperidol and chlorpromazine had less favorable cardiac safety profiles than olanzapine. Among atypical agents, risperidone had a similar cardiac safety profile to olanzapine, whereas quetiapine was associated with 30% and 20% lower risks of SD/VA and death, respectively, compared to olanzapine. These measured risks do not correlate well with average QT prolongation, further supporting the notion that average QT prolongation may be a poor surrogate of antipsychotic arrhythmogenicity.

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