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.