Antipsychotic medication and long-term mortality risk in patients with schizophrenia; a systematic review and meta-analysis

Patients with schizophrenia have a higher mortality risk than patients suffering from any other psychiatric disorder. Previous research is inconclusive regarding the association of antipsychotic treatment with long-term mortality risk. To this aim, we systematically reviewed the literature and performed a meta-analysis on the relationship between long-term mortality and exposure to antipsychotic medication in patients with schizophrenia. The objectives were to (i) determine long-term mortality rates in patients with schizophrenia using any antipsychotic medication; (ii) compare these with mortality rates of patients using no antipsychotics; (iii) explore the relationship between cumulative exposure and mortality; and (iv) assess causes of death. We systematically searched the EMBASE, MEDLINE and PsycINFO databases for studies that reported on mortality and antipsychotic medication and that included adults with schizophrenia using a follow-up design of more than 1 year. A total of 20 studies fulfilled our inclusion criteria. These studies reported 23,353 deaths during 821,347 patient years in 133,929 unique patients. Mortality rates varied widely per study. Meta-analysis on a subgroup of four studies showed a consistent trend of an increased long-term mortality risk in schizophrenia patients who did not use antipsychotic medication during follow-up. We found a pooled risk ratio of 0.57 (LL:0.46 UL:0.76 p value <0.001) favouring any exposure to antipsychotics. Statiscal heterogeneity was found to be high (Q = 39.31, I2 = 92.37%, p value < 0.001). Reasons for the increased risk of death for patients with schizophrenia without antipsychotic medication require further research. Prospective validation studies, uniform measures of antipsychotic exposure and classified causes of death are commendable.

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Long-term mortality in young patients with spontaneous intracerebral haemorrhage: Predictors and causes of death

European Stroke Journal ◽

10.1177/23969873211017723 ◽

2021 ◽

Vol 6 (2) ◽

pp. 185-193

Author(s):

Jamie I Verhoeven ◽

Marco Pasi ◽

Barbara Casolla ◽

Hilde Hénon ◽

Frank-Erik de Leeuw ◽

...

Keyword(s):

Mortality Risk ◽

Intracerebral Haemorrhage ◽

Causes Of Death ◽

Cox Regression ◽

Young Patients ◽

University Hospital ◽

Standardized Mortality Ratio ◽

Excessive Alcohol Consumption ◽

Long Term Mortality

Introduction Intracerebral haemorrhage (ICH) in young adults is rare but has devastating consequences. We investigated long-term mortality rates, causes of death and predictors of long-term mortality in young spontaneous ICH survivors. Patients and methods We included consecutive patients aged 18–55 years from the Prognosis of Intracerebral Haemorrhage cohort (PITCH), a prospective observational cohort of patients admitted to Lille University Hospital (2004–2009), who survived at least 30 days after spontaneous ICH. We studied long-term mortality with Kaplan-Meier analyses, collected causes of death, performed uni-/multivariable Cox-regression analyses for the association of baseline characteristics with long-term mortality. Results Of 560 patients enrolled in the PITCH, 75 patients (75% men) met our inclusion criteria (median age 50 years, interquartile range [IQR] 44–53 years). During a median follow-up of 8.2 years (IQR 5.0–10.1), 26 patients died (35%), with a standardized mortality ratio of 13.0 (95% confidence interval [95% CI] 8.5–18.0) compared to peers from the general population. Causes of death were vascular in 7 (27%) patients, non-vascular in 13 (50%) and unknown in 6 (23%). Global cerebral atrophy (hazard ratio [HR] 3.0, 95% CI 1.1–8.6), modified Rankin Score >2 before ICH (HR 3.4, 95% CI 1.0–11.0), and excessive alcohol consumption (HR 3.3, 95% CI 1.1–10.2) were independently associated with long-term mortality. Discussion We found a 13-fold higher mortality risk for young ICH survivors compared to the general French population. Predictors of long-term mortality were pre-existing conditions, not ICH-characteristics. Conclusion Young ICH survivors remain at increased mortality risk of vascular and non-vascular death for years after ICH.

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Abstract P075: Influence of Systemic Interleukin-6 on the Inverse Association between Your-Choice American Heart Diet and a 41-Year Mortality Risk from Coronary Heart Disease among Men

Circulation ◽

10.1161/circ.129.suppl_1.p075 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Jun Dai ◽

Anthony J Acton ◽

Robert V Considine ◽

Ruth E Krasnow ◽

Terry Reed

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Systemic Inflammation ◽

Mortality Risk ◽

Interleukin 6 ◽

Reactive Protein ◽

Chd Risk ◽

Long Term Mortality

Introduction: Whole diet evaluated using dietary pattern is associated with systemic inflammation and coronary heart disease (CHD). Systemic inflammation also contributes to CHD risk. Genetic factors explain variations in whole diet, systemic inflammation, and CHD. However, it is unknown whether systemic inflammation is a mechanism linking whole diet to the long-term mortality risk from coronary heart disease independent of genes. Hypothesis: Systemic inflammation measured as plasma interleukin-6 levels medicates the association between whole diet and long-term mortality risk from coronary heart disease independent of genes. Methods: From the National Heart, Lung, and Blood Institute Twin Study, we included 554 white, middle-aged, veteran male twins (105 monozygotic and 109 dizygotic twin pairs; 65 monozygotic and 61 dizygotic unpaired twins). The twins were not on antihypertensive medication and had diastolic blood pressure below 105 mmHg at baseline (1969-1973) and did not have suspected acute inflammation [plasma levels of interleukin-6 (IL-6) above 10 pg/mL or C-reactive protein above 30 mg/L)]. Usual dietary data at baseline were collected through nutritionist-administered dietary history interview. Your-Choice American Heart Diet (YCARD) score was devised to quantitatively evaluate whole diet. Plasma interleukin-6 and C-reactive protein levels were measured with ELISA. Data on vital status and death causes were collected through death certificates until Dec 31, 2010. A frailty survival model was used to estimate various associations: overall (equivalent to the association in the general population), within-pair (independent of genes and environment common to co-twins), and between-pair (indicating influence of the common factors). We controlled for total caloric intake and known CHD risk factors including body mass index and modified Framingham Risk Score. Results: There were 75 CHD deaths during a 41-year follow-up (median follow-up of 34 years). The adjusted overall association between YCARD score and the CHD mortality risk was negative [partial coefficient for a 10-unit increment in the YCARD score: βo (95% confidence interval (CI)): -0.13 (-0.24, -0.02); hazard ratio (95% CI): 0.88 (0.78, 0.98)]. The partial regression coefficient was -0.02 [95% CI (-0.23, 0.19)] for the within-pair effect of YCARD (βw) and -0.12 [95% CI (-0.26, 0)] for the between-pair effect of YCARD (βb) in relation to CHD mortality risk. Additional adjustment for IL-6 led to a 15.4% reduction in the βo, a 100% increment in the βw, and a 16.7% reduction in the βb. Conclusions: Systemic inflammation measured as interleukin-6 mediates the association between whole diet and long-term coronary heart mortality risk, which is largely through genetic and environmental factors shared between co-twins.

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P1855Multiple and posterior location of moderate paravalvular leaks are associated with worse long-term outcome after successful TAVR

European Heart Journal ◽

10.1093/eurheartj/ehz748.0606 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Kalinczuk ◽

Z Chmielak ◽

K Zielinski ◽

G S Mintz ◽

M Dabrowski ◽

...

Keyword(s):

Clinical Importance ◽

Mortality Rates ◽

Paravalvular Leak ◽

Single Center ◽

Term Outcome ◽

Long Term Outcome ◽

Common Location ◽

Long Term Mortality

Abstract Background Posterior location of a paravalvular leak (PVL) affects left ventricle fluid dynamics in a more unfavorable way than leaks of the other locations. Purpose To assess impact of the PVL location and its grade on subsequent long term mortality after successful TAVR. Methods Out of 445 consecutive patients treated between 8/2009 and 10/2017 within the single-center, prospective TAVR Registry, there were 432 pts [median 83.0 years of age, 63.4% female] with device success (97.1%) as per VARC-2. Post-procedural TTE studies done within 7 days post-TAVR were analyzed for PVL location (anterior vs posterior vs medial vs lateral) and grade (none/trace/mild vs moderate). Long-term mortality was assessed. Results Median follow-up was 29.3 (15.8–53.1) months with 1-year follow-up in all pts. The 30-day and 1-year mortality rates were 3.0% (n=13) and 13.4% (n=58) with an estimated 4-year mortality of 35.5%. Moderate PVL was reported in 28.5% (n=123) of pts, with 12.0% (n=52) having multiple locations (>1 PVL). Among moderate PVLs (n=184), most were of anterior (33.2%), 29.3% were posterior, 25.2% were lateral, and the least common location was medial (12.0%). Whereas moderate PVL alone was not associated with worse long-term outcome, the 1-year mortality rates tended to be higher for pts with PVL found at multiple or posterior locations (19.2% vs 12.6% among the rest of the subjects, p=0.20, and 18.5% vs 12.7%, p=0.28, respectively). The KM curves suggest mid-term clinical importance of multiple or posterior PVLs (Fig 1A and 1B). Figure 1 Conclusions Moderate PVL found in multiple locations or recognized in the posterior location tend to be associated with worse midterm (1–2 years) prognosis after successful TAVR.

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Perioperative- and Long-Term Mortality Rates After Major Vascular Surgery: The Relationship to Preoperative Testing in the Medicare Population

Anesthesia & Analgesia ◽

10.1097/00000539-199910000-00007 ◽

1999 ◽

Vol 89 (4) ◽

pp. 849 ◽

Cited By ~ 11

Author(s):

Lee A. Fleisher ◽

Kim A. Eagle ◽

Thomas Shaffer ◽

Gerard F. Anderson

Keyword(s):

Vascular Surgery ◽

Mortality Rates ◽

Preoperative Testing ◽

Medicare Population ◽

The Relationship ◽

Major Vascular Surgery ◽

Long Term Mortality

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Prognostic value of glycated hemoglobin among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-0792 ◽

2017 ◽

Vol 55 (8) ◽

pp. 1090-1099 ◽

Cited By ~ 3

Author(s):

Guangxiao Li ◽

Xiaowen Hou ◽

Ying Li ◽

Peng Zhang ◽

Qiongrui Zhao ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Risk ◽

Glycated Hemoglobin ◽

Meta Analysis ◽

Sufficient Information ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Long Term Mortality

Abstract Many studies have shown the prognostic significance of glycated hemoglobin (HbA1c) for overall coronary artery disease (CAD). But less is known about the role that HbA1c played in the prognosis of patients diagnosed with ST-segment elevation myocardial infarction (STEMI). Results from previous studies were controversial. Therefore, a meta-analysis was conducted to investigate whether admission HbA1c level was a predictor of short- and long-term mortality rates among patients diagnosed with STEMI. Relevant literatures were retrieved from the electronic databases up to March 2016. Reference lists were hand searched to identify eligible studies. Articles were included if they provided sufficient information for the calculation of pooled relative risk (RR) and its corresponding 95% confidence interval (CI). Finally, we got 19 prospective studies involving a total of 35,994 STEMI patients to evaluate the associations between HbA1c level and their in-hospital, 30-day and long-term mortality. Among STEMI patients, HbA1c level was not significantly associated with in-hospital mortality (RR 1.20, 95% CI 0.95–1.53, p=0.13). However, elevated HbA1c level was positively associated with risk of 30-day and long-term mortality (for 30-day mortality, RR 1.25, 95% CI 1.03–1.52, p=0.02; for long-term mortality, RR 1.45, 95% CI 1.20–1.76, p<0.01). In conclusion, our findings suggested elevated HbA1c level among STEMI patients was an indicator of 1.25-fold 30-day mortality risk and 1.45-fold long-term mortality risk, respectively. STEMI patients with high HbA1c level should have their chronic glucose dysregulation under intensive control.

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TCT-188 Short- and Long-Term Mortality Risk for Alternative Transcatheter Aortic Valve Replacement Access Routes: A Frequentist Network Meta-Analysis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2021.09.1041 ◽

2021 ◽

Vol 78 (19) ◽

pp. B77

Author(s):

Sagar Ranka ◽

Shubham Lahan

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mortality Risk ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Transcatheter Aortic Valve ◽

Short And Long Term ◽

Long Term Mortality

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Paclitaxel-Coated or Uncoated Devices: Significant Differences in Patient Populations and Mortality Led to Study Incomparability

10.1101/2021.01.29.21250732 ◽

2021 ◽

Author(s):

Chenyang Zhang ◽

Guosheng Yin

Keyword(s):

Relative Risk ◽

Interim Analysis ◽

Meta Analysis ◽

Credible Interval ◽

Mortality Rates ◽

Control Groups ◽

Random Effects Models ◽

And Control

AbstractThe SWEDEPAD trial reported an unplanned interim analysis to show no difference in the mortality rate between the paclitaxel-coated and uncoated groups (Nordanstig et al., 2020), which contradicts the long-term risk of paclitaxel-coated devices claimed by a meta-analysis (Katsanos et al., 2018). However, there existed significant differences in mortality rates between the SWEDEPAD trial and the trials included in the meta-analysis, which were caused by significant differences in the patient populations. As a result, the SWEDEPAD trial and meta-analysis results are not directly comparable. An updated meta-analysis including the SWEDPEPAD trial and all studies in the meta-analysis (Katsanos et al., 2018) shows marginal differences in mortality rates between the paclitaxel-coated and control groups at two years with Bayesian relative risk (RR) 1.39 (95% credible interval (CrI) [1.01, 2.39]) and frequentist RR 1.16 (95% confidence interval (CI) [0.99, 1.36]) and differences in mortality rates during the entire follow-up period with Bayesian RR 1.29 (95% CrI [1.01, 1.72]) and frequentist RR 1.13 (95% CI [0.99, 1.28]) under random-effects models. Given the relatively short follow-up thus far in the SWEDEPAD trial (with a mean follow-up of 2.49 years) and the paclitaxel-coated risk being long-term (e.g., 4 or 5 years), the interim results on the risk of paclitaxel-coated devices reported by the SWEDEPAD trial warrant further investigation.

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