Age effect of antipsychotic medications on the risk of sudden cardiac death in patients with schizophrenia: A nationwide
            case–crossover
            study

ObjectiveTo testa priorihypothesis of an association between season-specific cold spells and sudden cardiac death (SCD).MethodsWe conducted a case–crossover study of 3614 autopsy-verified cases of SCD in the Province of Oulu, Finland (1998–2011). Cold spell was statistically defined by applying an individual frequency distribution of daily temperatures at the home address during the hazard period (7 days preceding death) and 50 reference periods (same calendar days of other years) for each case using the home coordinates. Conditional logistic regression was applied to estimate ORs for the association between the occurrence of cold spells and the risk of SCD after controlling for temporal trends.ResultsThe risk of SCD was associated with a preceding cold spell (OR 1.33; 95% CI 1.00, 1.78). A greater number of cold days preceding death increased the risk of SCD approximately 19% per day (OR 1.19; 95% CI 1.07 to 1.32). The association was strongest during autumn (OR 2.51; 95% CI 1.27 to 4.96) and winter (OR 1.70; 95% CI 1.13 to 2.55) and lowest during summer (OR 0.42; 95% CI 0.15 to 1.18) and spring (OR 0.89; 95% CI 0.45 to 1.79). The association was stronger for ischaemic (OR 1.55; 95% CI 1.12 to 2.13) than for non-ischaemic SCD (OR 0.68; 95% CI 0.32 to 1.45) verified by medicolegal autopsy.ConclusionsOur results indicate that there is an association between cold spells and SCD, that this association is strongest during autumn, when the weather event is prolonged, and with cases suffering ischaemic SCD. These findings are subsumed with potential prevention via weather forecasting, medical advice and protective behaviour.

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Antipsychotic Drugs and the Risk of Ventricular Arrhythmia and/or Sudden Cardiac Death: A Nation‐wide Case‐Crossover Study

Journal of the American Heart Association ◽

10.1161/jaha.114.001568 ◽

2015 ◽

Vol 4 (2) ◽

Cited By ~ 61

Author(s):

Chi‐Shin Wu ◽

Yu‐Ting Tsai ◽

Hui‐Ju Tsai

Keyword(s):

Sudden Cardiac Death ◽

Ventricular Arrhythmia ◽

Crossover Study ◽

Cardiac Death ◽

Antipsychotic Drugs ◽

Case Crossover

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Age Effect on Incidence, Physical, and Psychiatric Comorbidity for Sudden Cardiac Death in Schizophrenia: Effet de l’âge sur l’incidence, la comorbidité physique et psychiatrique de la mort cardiaque subite dans la schizophrénie

The Canadian Journal of Psychiatry ◽

10.1177/0706743720948429 ◽

2020 ◽

pp. 070674372094842

Author(s):

Pao-Huan Chen ◽

Shang-Ying Tsai ◽

Chun-Hung Pan ◽

Hu-Ming Chang ◽

Yi-Lung Chen ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Mental Disorder ◽

Cardiac Death ◽

Psychiatric Comorbidity ◽

Age Effect ◽

Research Database ◽

Drug Induced ◽

National Cohort ◽

Male Patients ◽

Standardized Mortality Ratios

Objective: The pathogenesis of sudden cardiac death may differ between younger and older adults in schizophrenia, but evidence remains scant. This study investigated the age effect on the incidence and risk of the physical and psychiatric comorbidity for sudden cardiac death. Methods: Using 2000 to 2016 data from the Taiwan National Health Insurance Research Database and Department of Health Death Certification System, we identified a national cohort of 170,322 patients with schizophrenia, 1,836 of whom had a sudden cardiac death. Standardized mortality ratios (SMRs) were estimated. Hazard ratios and population attributable fractions of distinctive comorbidities for sudden cardiac death were assessed. Results: The SMRs of sudden cardiac death were all >1.00 across each age group for both sexes, with the highest SMR in male patients aged <35 years (30.88, 95% CI: 26.18–36.18). The fractions of sudden cardiac death attributable to hypertension and congestive heart failure noticeably increased with age. By contrast, the fraction attributable to drug-induced mental disorder decreased with age. Additionally, chronic hepatic disease and sleep disorder increased the risk of sudden cardiac death in patients aged <35 years. Dementia and organic mental disorder elevated the risk in patients aged between 35–54 years. Ischemic heart disease raised the risk in patients aged ≥55 years. Conclusions: The risk is increased across the lifespan in schizophrenia, particularly for younger male patients. Furthermore, physical and psychiatric comorbidities have age-dependent risks. The findings suggest that prevention strategies targeted toward sudden cardiac death in patients with schizophrenia must consider the age effect.

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Coronary stenosis as a modifier of the effect of cold spells on the risk of sudden cardiac death: a case-crossover study in Finland

BMJ Open ◽

10.1136/bmjopen-2017-020865 ◽

2018 ◽

Vol 8 (8) ◽

pp. e020865

Author(s):

Niilo R I Ryti ◽

M Juhani Junttila ◽

Harri Antikainen ◽

Marja-Leena Kortelainen ◽

Heikki V Huikuri ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Coronary Stenosis ◽

Conditional Logistic Regression ◽

Temporal Trends ◽

Cold Weather ◽

Weather Data ◽

Channel Blockers ◽

Total Occlusion ◽

Case Crossover

ObjectiveTo test the a priori hypothesis that the association between cold spells and ischaemic sudden cardiac death (SCD) is modified by the severity of coronary stenosis.MethodsThe home coordinates of 2572 autopsy-verified cases of ischaemic SCD aged ≥35 in the Province of Oulu, Finland, were linked to 51 years of weather data. Cold spell was statistically defined for each home address as unusually cold weather pertinent to the location and time of year. We estimated the occurrence of cold spells during the hazard period (7 days preceding death) and reference periods (the same calendar days over 51 years) in a case-crossover setting applying conditional logistic regression, controlling for temporal trends and stratifying by severity of coronary stenosis.ResultsThe association between cold spells and ischaemic SCD was stronger among patients with 75%–95% stenosis (OR 2.03; 95% CI 1.31 to 3.17), and weaker to non-existent among patients with <75% stenosis (OR 0.97; 95% CI 0.37 to 2.55) or coronary total occlusion (100% stenosis) (OR 1.01; 95% CI 0.52 to 1.96). Lack of calcium-channel blockers and statin therapy seemed to accentuate the role of stenosis during cold spells.ConclusionsWe provide evidence that the association between cold spells and ischaemic SCD is modified by the severity of coronary stenosis. The findings suggest that disturbances in coronary circulation play part in the pathogenesis of SCD during cold weather.

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Antipsychotic medications and stroke in schizophrenia: A case-crossover study

PLoS ONE ◽

10.1371/journal.pone.0179424 ◽

2017 ◽

Vol 12 (6) ◽

pp. e0179424 ◽

Cited By ~ 10

Author(s):

Wen-Yin Chen ◽

Lian-Yu Chen ◽

Hsing-Cheng Liu ◽

Chi-Shin Wu ◽

Shu-Yu Yang ◽

...

Keyword(s):

Crossover Study ◽

Antipsychotic Medications ◽

Case Crossover

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Sudden cardiac death and antipsychotic medications: literature review

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2012-5-79-82 ◽

2012 ◽

Vol 11 (5) ◽

pp. 79-82

Author(s):

V. P. Volkov

Keyword(s):

Risk Factors ◽

Sudden Cardiac Death ◽

Literature Review ◽

Cardiac Arrhythmias ◽

Qt Interval ◽

Cardiac Death ◽

Psychiatric Patients ◽

Epidemiological Data ◽

Antipsychotic Medications ◽

Electrocardiographic Changes

The review summarises the evidence from international publications on sudden cardiac death (SCD) in psychiatric patients receiving neuroleptics. Modern SCD definitions are presented, together with the relevant epidemiological data. The pathogenesis of fatal cardiac arrhythmias, caused by cardiotoxic effects of antipsychotic medications, is discussed. Electrocardiographic changes, in particular QT interval changes, as well as risk factors of SCD and main principles of its prevention, are described in detail.

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