Electrocardiogram Characteristics and Their Association With Psychotropic Drugs Among Patients With Schizophrenia
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Electrocardiogram Characteristics and Their Association With Psychotropic Drugs Among Patients With Schizophrenia. / Polcwiartek, Christoffer; Kragholm, Kristian; Hansen, Steen M; Atwater, Brett D; Friedman, Daniel J; Barcella, Carlo A; Graff, Claus; Nielsen, Jonas B; Pietersen, Adrian; Nielsen, Jimmi; Søgaard, Peter; Torp-Pedersen, Christian; Jensen, Svend E.
In: Schizophrenia Bulletin, Vol. 46, No. 2, 2020, p. 354-362.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Electrocardiogram Characteristics and Their Association With Psychotropic Drugs Among Patients With Schizophrenia
AU - Polcwiartek, Christoffer
AU - Kragholm, Kristian
AU - Hansen, Steen M
AU - Atwater, Brett D
AU - Friedman, Daniel J
AU - Barcella, Carlo A
AU - Graff, Claus
AU - Nielsen, Jonas B
AU - Pietersen, Adrian
AU - Nielsen, Jimmi
AU - Søgaard, Peter
AU - Torp-Pedersen, Christian
AU - Jensen, Svend E
N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.
PY - 2020
Y1 - 2020
N2 - BACKGROUND: There are limited data on electrocardiogram (ECG) characteristics and their association with psychotropic drugs in schizophrenia.METHODS: Using a cross-sectional design, we included Danish primary care patients with first-time digital ECGs from 2001 to 2015. Patients diagnosed with schizophrenia before ECG recording were matched 1:5 on age, sex, and ECG recording year to controls without psychiatric disease. Multivariable logistic regression was used to compute odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: We included 4486 patients with schizophrenia matched with 22 430 controls (median age, 47 years; male, 55%). Between groups, the prevalence of abnormal ECGs was similar (54%, P = .536), but patients with schizophrenia demonstrated higher median heart rate (79 vs 69 beats per minute, P < .001) and Fridericia-corrected QT (QTc) interval (416 vs 412 ms, P < .001) than controls. QTc prolongation was also more prevalent among patients with schizophrenia (3.4% vs 1.1%, P < .001), and so were pathological Q waves (5.3% vs 3.9%, P < .001). Patients with schizophrenia less frequently demonstrated left ventricular hypertrophy (6.1% vs 9.6%, P < .001) and atrial fibrillation or flutter (0.7% vs 1.4%, P < .001). Among patients with schizophrenia only, particularly antipsychotics were associated with abnormal ECGs (OR, 1.20; 95% CI, 1.04-1.39).CONCLUSIONS: Patients with schizophrenia demonstrate a different cardiovascular risk profile than matched controls without psychiatric disease, with higher prevalence of elevated heart rate, QTc prolongation, and pathological Q waves, and lower prevalence of left ventricular hypertrophy and atrial fibrillation or flutter. Particularly antipsychotics were associated with abnormal ECGs. This underscores an integrated care approach when ECG abnormalities are detected in this group.
AB - BACKGROUND: There are limited data on electrocardiogram (ECG) characteristics and their association with psychotropic drugs in schizophrenia.METHODS: Using a cross-sectional design, we included Danish primary care patients with first-time digital ECGs from 2001 to 2015. Patients diagnosed with schizophrenia before ECG recording were matched 1:5 on age, sex, and ECG recording year to controls without psychiatric disease. Multivariable logistic regression was used to compute odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: We included 4486 patients with schizophrenia matched with 22 430 controls (median age, 47 years; male, 55%). Between groups, the prevalence of abnormal ECGs was similar (54%, P = .536), but patients with schizophrenia demonstrated higher median heart rate (79 vs 69 beats per minute, P < .001) and Fridericia-corrected QT (QTc) interval (416 vs 412 ms, P < .001) than controls. QTc prolongation was also more prevalent among patients with schizophrenia (3.4% vs 1.1%, P < .001), and so were pathological Q waves (5.3% vs 3.9%, P < .001). Patients with schizophrenia less frequently demonstrated left ventricular hypertrophy (6.1% vs 9.6%, P < .001) and atrial fibrillation or flutter (0.7% vs 1.4%, P < .001). Among patients with schizophrenia only, particularly antipsychotics were associated with abnormal ECGs (OR, 1.20; 95% CI, 1.04-1.39).CONCLUSIONS: Patients with schizophrenia demonstrate a different cardiovascular risk profile than matched controls without psychiatric disease, with higher prevalence of elevated heart rate, QTc prolongation, and pathological Q waves, and lower prevalence of left ventricular hypertrophy and atrial fibrillation or flutter. Particularly antipsychotics were associated with abnormal ECGs. This underscores an integrated care approach when ECG abnormalities are detected in this group.
KW - Adult
KW - Antipsychotic Agents/adverse effects
KW - Cross-Sectional Studies
KW - Denmark
KW - Electrocardiography/drug effects
KW - Female
KW - Heart Diseases/chemically induced
KW - Heart Rate/drug effects
KW - Humans
KW - Long QT Syndrome/chemically induced
KW - Male
KW - Middle Aged
KW - Polypharmacy
KW - Schizophrenia/drug therapy
U2 - 10.1093/schbul/sbz064
DO - 10.1093/schbul/sbz064
M3 - Journal article
C2 - 31219596
VL - 46
SP - 354
EP - 362
JO - Schizophrenia Bulletin
JF - Schizophrenia Bulletin
SN - 0586-7614
IS - 2
ER -
ID: 257037570