QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy

Anja Friis Elliott, Thibault Johan Mørk, Mikkel Højlund, Thomas Christensen, Rasmus Jeppesen, Nikolaj Madsen, Anne Grethe Viuff, Peter Hjorth, Jens Cosedis Nielsen, Povl Munk-Jørgensen

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Resumé

Objective: Antipsychotics are associated with a polymorphic ventricular tachycardia, torsades de pointes, which, in the worst case, can lead to sudden cardiac death. The QT interval corrected for heart rate (QTc) is used as a clinical proxy for torsades de pointes. The QTc interval can be prolonged by antipsychotic monotherapy, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmaceutical treatment. Therefore, this study investigated the associations between QTc interval and antipsychotic monotherapy and antipsychotic polypharmaceutical treatment in schizophrenia, and measured the frequency of QTc prolongation among patients.

Methods: We carried out an observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the region of Central Jutland, Denmark. Patients were enrolled from January of 2013 to June of 2015, with follow-up until June of 2015. Data were collected from clinical interviews and clinical case records.

Results: Electrocardiograms were available for 65 patients, and 6% had QTc prolongation. We observed no difference in average QTc interval for the whole sample of patients receiving no antipsychotics, antipsychotic monotherapy, or antipsychotic polypharmaceutical treatment (p=0.29). However, women presented with a longer QTc interval when receiving polypharmacy than when receiving monotherapy (p=0.01). A limitation of this study was its small sample size.

Conclusions: We recommend an increased focus on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy.

OriginalsprogEngelsk
TidsskriftCNS Spectrums
Vol/bind23
Udgave nummer4
Sider (fra-til)278-283
ISSN1092-8529
DOI
StatusUdgivet - aug. 2018

Fingeraftryk

Torsades de Pointes
Proxy
Denmark
Sample Size
Electrocardiography
Cohort Studies
Outpatients
Interviews

Citer dette

Elliott, A. F., Johan Mørk, T., Højlund, M., Christensen, T., Jeppesen, R., Madsen, N., ... Munk-Jørgensen, P. (2018). QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy. CNS Spectrums, 23(4), 278-283. https://doi.org/10.1017/S1092852917000402
Elliott, Anja Friis ; Johan Mørk, Thibault ; Højlund, Mikkel ; Christensen, Thomas ; Jeppesen, Rasmus ; Madsen, Nikolaj ; Grethe Viuff, Anne ; Hjorth, Peter ; Cosedis Nielsen, Jens ; Munk-Jørgensen, Povl. / QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy. I: CNS Spectrums. 2018 ; Bind 23, Nr. 4. s. 278-283.
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abstract = "Objective: Antipsychotics are associated with a polymorphic ventricular tachycardia, torsades de pointes, which, in the worst case, can lead to sudden cardiac death. The QT interval corrected for heart rate (QTc) is used as a clinical proxy for torsades de pointes. The QTc interval can be prolonged by antipsychotic monotherapy, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmaceutical treatment. Therefore, this study investigated the associations between QTc interval and antipsychotic monotherapy and antipsychotic polypharmaceutical treatment in schizophrenia, and measured the frequency of QTc prolongation among patients.Methods: We carried out an observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the region of Central Jutland, Denmark. Patients were enrolled from January of 2013 to June of 2015, with follow-up until June of 2015. Data were collected from clinical interviews and clinical case records.Results: Electrocardiograms were available for 65 patients, and 6{\%} had QTc prolongation. We observed no difference in average QTc interval for the whole sample of patients receiving no antipsychotics, antipsychotic monotherapy, or antipsychotic polypharmaceutical treatment (p=0.29). However, women presented with a longer QTc interval when receiving polypharmacy than when receiving monotherapy (p=0.01). A limitation of this study was its small sample size.Conclusions: We recommend an increased focus on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy.",
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Elliott, AF, Johan Mørk, T, Højlund, M, Christensen, T, Jeppesen, R, Madsen, N, Grethe Viuff, A, Hjorth, P, Cosedis Nielsen, J & Munk-Jørgensen, P 2018, 'QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy', CNS Spectrums, bind 23, nr. 4, s. 278-283. https://doi.org/10.1017/S1092852917000402

QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy. / Elliott, Anja Friis; Johan Mørk, Thibault; Højlund, Mikkel; Christensen, Thomas; Jeppesen, Rasmus; Madsen, Nikolaj; Grethe Viuff, Anne; Hjorth, Peter; Cosedis Nielsen, Jens; Munk-Jørgensen, Povl.

I: CNS Spectrums, Bind 23, Nr. 4, 08.2018, s. 278-283.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy

AU - Elliott, Anja Friis

AU - Johan Mørk, Thibault

AU - Højlund, Mikkel

AU - Christensen, Thomas

AU - Jeppesen, Rasmus

AU - Madsen, Nikolaj

AU - Grethe Viuff, Anne

AU - Hjorth, Peter

AU - Cosedis Nielsen, Jens

AU - Munk-Jørgensen, Povl

PY - 2018/8

Y1 - 2018/8

N2 - Objective: Antipsychotics are associated with a polymorphic ventricular tachycardia, torsades de pointes, which, in the worst case, can lead to sudden cardiac death. The QT interval corrected for heart rate (QTc) is used as a clinical proxy for torsades de pointes. The QTc interval can be prolonged by antipsychotic monotherapy, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmaceutical treatment. Therefore, this study investigated the associations between QTc interval and antipsychotic monotherapy and antipsychotic polypharmaceutical treatment in schizophrenia, and measured the frequency of QTc prolongation among patients.Methods: We carried out an observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the region of Central Jutland, Denmark. Patients were enrolled from January of 2013 to June of 2015, with follow-up until June of 2015. Data were collected from clinical interviews and clinical case records.Results: Electrocardiograms were available for 65 patients, and 6% had QTc prolongation. We observed no difference in average QTc interval for the whole sample of patients receiving no antipsychotics, antipsychotic monotherapy, or antipsychotic polypharmaceutical treatment (p=0.29). However, women presented with a longer QTc interval when receiving polypharmacy than when receiving monotherapy (p=0.01). A limitation of this study was its small sample size.Conclusions: We recommend an increased focus on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy.

AB - Objective: Antipsychotics are associated with a polymorphic ventricular tachycardia, torsades de pointes, which, in the worst case, can lead to sudden cardiac death. The QT interval corrected for heart rate (QTc) is used as a clinical proxy for torsades de pointes. The QTc interval can be prolonged by antipsychotic monotherapy, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmaceutical treatment. Therefore, this study investigated the associations between QTc interval and antipsychotic monotherapy and antipsychotic polypharmaceutical treatment in schizophrenia, and measured the frequency of QTc prolongation among patients.Methods: We carried out an observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the region of Central Jutland, Denmark. Patients were enrolled from January of 2013 to June of 2015, with follow-up until June of 2015. Data were collected from clinical interviews and clinical case records.Results: Electrocardiograms were available for 65 patients, and 6% had QTc prolongation. We observed no difference in average QTc interval for the whole sample of patients receiving no antipsychotics, antipsychotic monotherapy, or antipsychotic polypharmaceutical treatment (p=0.29). However, women presented with a longer QTc interval when receiving polypharmacy than when receiving monotherapy (p=0.01). A limitation of this study was its small sample size.Conclusions: We recommend an increased focus on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy.

KW - antipsychotics

KW - polypharmacy

KW - QTc

KW - schizophrenia

KW - sex difference

U2 - 10.1017/S1092852917000402

DO - 10.1017/S1092852917000402

M3 - Journal article

C2 - 28659221

AN - SCOPUS:85021406439

VL - 23

SP - 278

EP - 283

JO - CNS Spectrums

JF - CNS Spectrums

SN - 1092-8529

IS - 4

ER -