Electrocardiogram Characteristics and Their Association With Psychotropic Drugs Among Patients With Schizophrenia.

Abstract

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.

• Authors: Christoffer Polcwiartek, Kristian Kragholm, Steen M Hansen, Brett D Atwater, Daniel J Friedman, Carlo A Barcella, Claus Graff, Jonas B Nielsen, Adrian Pietersen, Jimmi Nielsen, Peter Søgaard, Christian Torp-Pedersen, Svend E Jensen
• Journal: Schizophrenia bulletin (Schizophr Bull) Vol. 46 Issue 2 Pg. 354-362 (02 26 2020) ISSN: 1745-1701 [Electronic] United States
• PMID: 31219596 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2019. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Antipsychotic Agents

Topics

• Adult
• Antipsychotic Agents (adverse effects)
• Cross-Sectional Studies
• Denmark
• Electrocardiography (drug effects)
• Female
• Heart Diseases (chemically induced)
• Heart Rate (drug effects)
• Humans
• Long QT Syndrome (chemically induced)
• Male
• Middle Aged
• Polypharmacy
• Schizophrenia (drug therapy)