Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults ‐ a Swedish nationwide study

Danielsson, Bengt; Collin, Julius; Bergman, Gudrun Jonasdottir; Borg, Natalia; Salmi, Peter; Fastbom, Johan

doi:10.1111/bcp.12829

Cited by 72 publications

(42 citation statements)

References 43 publications

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“…When the BNF sections are categorized into different types of comorbidity medications (Table 3), those on anti-arrhythmic and diabetic medication had significantly higher mortality rates in comparison to PwD with no comorbidities. Although this finding should be interpreted with caution, as it is a proxy measure rather than an official diagnosis of the comorbidities, the findings dovetail those of recent studies which suggest that those with diabetes and arrhythmic conditions have higher mortality rates [36,37]. Moreover, PwD who have also been diagnosed with dementia have poorer medication management and are less likely to receive the recommended annual monitoring for diabetes than people without dementia [38].…”

Section: Discussionsupporting

confidence: 71%

Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland

McMichael¹,

Zafeiridi²,

Passmore³

et al. 2020

JAD

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Background: Understanding factors associated with mortality after a dementia diagnosis can provide essential information to the person with dementia, their family, and caregivers. To date very little is known about the factors associated with mortality after a dementia diagnosis in Northern Ireland. Objective: To determine how demographic and other factors such as deprivation and comorbidity medications influence mortality rates after a dementia diagnosis in Northern Ireland and whether these factors are influenced through nursing home transitions. Methods: 25,418 people prescribed anti-dementia medication were identified through the enhanced prescribing database between 2010 and 2016. The impact of covariates including age, gender, marital status, deprivation measure, urban/rural classification, and comorbidity medications were examined using cox proportional hazard models with hazard ratios (HR) and 95% confidence intervals. Results: Between 2010 and 2016, 12,129 deaths occurred, with 114 deaths/1,000 person years. Males had significantly higher mortality rates in comparison to females (HR = 1.28; 95%CI = 1.23-1.33); this was true regardless of whether the person with dementia transitioned to a nursing home. People prescribed anti-dementia drugs living with lower levels of deprivation had significantly lower mortality rates in comparison to people living with the highest levels of deprivation (HR = 0.93; 95%CI = 0.89-0.97). Diabetic (HR = 1.18; 95%CI = 1.07-1.29) and anti-arrhythmic (HR = 2.44; 95%CI = 1.01-5.91) medication in particular significantly influenced mortality. Conclusion: Male gender, higher comorbidity medications, and living in areas of higher deprivation significantly increased mortality rates for people prescribed anti-dementia drugs in our study population. When comorbidity medications were classified, only anti-arrhythmia and diabetic medications significantly increased mortality. Future research should continue to investigate factors which influence mortality after a dementia diagnosis.

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Section: Discussionsupporting

confidence: 71%

Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland

McMichael¹,

Zafeiridi²,

Passmore³

et al. 2020

JAD

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“…Considering that most elderly patients have numerous risk factors for TdP at baseline, the assessment of these, including electrocardiographic screening, should be carried out routinely by physicians before and after starting any drug that could prolong the QT interval . In the present study, diuretics (furosemide and hydrochlorothiazide) were the most commonly prescribed QT‐prolonging drugs and therefore their use requires close monitoring, especially because of their hypokalaemic effect and associated cardiovascular comorbidity.…”

Section: Discussionmentioning

confidence: 96%

“…High doses of such drugs are especially dangerous for women because they possess a relatively greater lipid : lean ratio and therefore more space for drug accumulation . A recent case‐control study of Swedish elderly patients consuming antidepressant and antipsychotic drugs showed that patients using drugs with a known or possible risk of TdP are at higher risk for mortality compared with drugs with a conditional risk or without a TdP classification .…”

Section: Discussionmentioning

confidence: 99%

High prevalence of risk factors in elderly patients using drugs associated with acquired torsades de pointes chronically in Colombia

Moreno-Gutiérrez

Gaviria‐Mendoza

Cañón

et al. 2016

Brit J Clinical Pharma

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AIMSMedication is one of the main causes of long QT syndrome (LQTS) and torsades de pointes (TdP), and the older adult population is at particularly high risk. The aim of the present study was to describe the prescription patterns of drugs with a risk of TdP in the Colombian older adult population. METHODSPatients older than 65 years who received medication with a risk of TdP during three consecutive months were selected. The medication was obtained and classified according to the QT Drug List from Crediblemeds.org. The data were analysed using SPSS-22. RESULTSA total of 55 932 patients were chronically receiving QT-prolonging drugs; 61.9% (n = 34 ,632) were women and the mean age of the sample was 75.6 years. Drugs with a conditional risk were consumed by 95.2% of patients, 5.3% received drugs with a known risk and 2.9% received drugs with a possible risk. Two or more QT-prolonging drugs were consumed by 10.3% of the patients (n = 5786). Most of the sample (96.8%, n = 54 170) had at least one additional risk factor for LQTS, with a mean of 3.1 ± 0.9 risk factors. Patients receiving QT-prolonging drugs for psychiatric and neurological disease were at a higher risk of major polypharmacy [odds ratio (OR) 3.0; 95% confidence interval (CI) 2.80, 3.22) and of receiving high doses of QT-prolonging drugs (OR 3.8; 95% CI 3.52, 4.05). CONCLUSIONSThe widespread use of medication that causes TdP and the high prevalence of additional risks in the older adult population raise the need for accurate prediction of risk and constant patient monitoring. Patients taking psychiatric drugs are at a higher risk of TdP. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Some drug classes are considered to be one of the main causes of long QT syndrome (LQTS) and torsades de pointes (TdP), and this serious adverse drug reaction has gained attention over time.• The older adult population using medication related to LQTS and TdP has multiple risk factors that may increase the probability of these adverse outcomes. • Studies have identified risk patterns for TdP in acute care but data on their chronic use are scarce. WHAT THIS STUDY ADDS• 10.6% of the older adult population in Columbia was found to consume chronically drugs with QT interval-prolonging potential. Most of these patients were consuming drugs with a conditional risk, but 98% of them had at least one risk factor for LQTS and TdP.• Use of QT-prolonging drugs for psychiatric and neurological disorders was higher among women, and increased with age. In addition, the use of this type of drug was associated with an increase in the risk of major polypharmacy, and of receiving concurrent use of more than one QT drug and high doses.• Clinicians should keep in mind that common cardiovascular and noncardiovascular drugs are associated with LQTS and TdP, and should routinely assess the associated risk factors, including an electrocardiographic study before and after prescribing these drugs.

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“…In particular, elongation of the QT interval, torsade de pointes (TdP), and sudden cardiac death have a known relationship with antipsychotic drugs (Sicouri and Antzelevitch, 2018). A case control study on a population aged 65 years or above, undertaking antipsychotics at possible or conditional risk of TdP, demonstrated higher TdP risk for drugs classified as "known TdP risk, " with risk ranking of haloperidol > risperidone > olanzapine > quetiapine (Danielsson et al, 2016). The risk of VTE is estimated to be double, compared to the general population, especially within the first three months of therapy, and several mechanisms are potentially responsible for this association.…”

Section: Antipsychotics and Safetymentioning

confidence: 99%

The Use of Antipsychotic Drugs for Treating Behavioral Symptoms in Alzheimer’s Disease

et al. 2019

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According to the World Alzheimer's report, dementia was estimated to affect 50 million worldwide in 2018, number expected to increase to more than 150 million within 30 years. Alzheimer's disease is the most common type of dementia, accounting on its own for 2/3 of all dementia cases. The initial signs and symptoms of Alzheimer's disease relate to progressive cognitive decline, inexorably progressing until the loss of independence. Neuropsychiatric and behavioral symptoms may occur during the progression of the disease; around 20% of patients without any behavioral symptoms at the diagnosis will experience some of them within 2 years. Consequences are early institutionalization, lower quality of life, of both patients and carers, and more severe cognitive impairment. Treatment options for behavioral symptoms include pharmacological and nonpharmacological approaches. The latter are usually preferred, since antipsychotic therapy is not free from several, and often serious, adverse events. However, behavioral symptoms are not always controllable with non-pharmacological intervention. The psychotropic class of medication more frequently prescribed for behavioral symptoms are atypical antipsychotics; among them, risperidone is the only one licensed for the treatment of aggression, in Europe but not in the USA. On that regard, the use of antipsychotic drugs should be limited, due to the increased risk of mortality, stroke, hallucination, and higher risk of relapse after discontinuation. Some new agents are under evaluation, such as pimavanserin and lumateperone. In this review, we are evaluating the current available pharmacological options to treat behavioral symptoms as well as the forthcoming new agents.

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Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults ‐ a Swedish nationwide study

Cited by 72 publications

References 43 publications

Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland

Factors Associated with Mortality Including Nursing Home Transitions: A Retrospective Analysis of 25,418 People Prescribed Anti-Dementia Drugs in Northern Ireland

High prevalence of risk factors in elderly patients using drugs associated with acquired torsades de pointes chronically in Colombia

The Use of Antipsychotic Drugs for Treating Behavioral Symptoms in Alzheimer’s Disease

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