Atypical antipsychotic drugs and the risk of sudden cardiac death
New England Journal of Medicine, 01/22/09

 

Ray WA et al. ? Current users of typical and atypical antipsychotic drugs had a similar, dose-related increased risk of sudden cardiac death. Methods

  • Retrospective cohort study of Medicaid enrollees in Tennessee for calculation of adjusted incidence of sudden cardiac death among current users of antipsychotic drugs
  • Primary analysis: baseline users of single typical (44,218) and atypical (46,089) drugs and matched nonusers of antipsychotic drugs (186,600)
  • Secondary analysis of antipsychotic drug users with no baseline diagnosis of schizophrenia or related psychoses and matched nonusers by propensity score
  • Propensity score: predicted probability as users of antipsychotic drugs
Results
  • Current users of typical and atypical antipsychotic drugs had higher rates of sudden cardiac death than did nonusers of antipsychotic drugs, with adjusted incidence-rate ratios of 1.99 and 2.26, respectively
  • Incidence-rate ratio for users of atypical antipsychotic drugs vs users of typical antipsychotic drugs: 1.14
  • Former users of antipsychotic drugs had no significantly increased risk (incidence-rate ratio, 1.13)
  • For both drug classes, risk for current users increased significantly with increasing dose
  • For users of typical antipsychotic drugs, incidence-rate ratios increased from 1.31 for low doses to 2.42 for high doses
  • For users of atypical agents, incidence-rate ratios increased from 1.59 for low doses to 2.86 for high doses
  • Similar findings in cohort matched for propensity score.

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