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Incidence of Cardiac Events among Children and Young Adults Exposed to Psychopharmacological Treatment (2006-2018) - A Nationwide Register-Based Study.
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  • Howaida Elmowafi,
  • Jenny Kindblom,
  • Linda Halldner,
  • David Gyllenberg,
  • Estelle Naumburg
Howaida Elmowafi
Umea Universitet

Corresponding Author:howaida.elmowafi@umu.se

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Jenny Kindblom
Sahlgrenska University Hospital
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Linda Halldner
Umea Universitet
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David Gyllenberg
Helsinki University Hospital Physiatry
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Estelle Naumburg
Umea Universitet
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Abstract

Abstract Aim: To assess cardiac event incidence and trends by sex and age in young patients on psychopharmacological treatment in Sweden. Methods: This nationwide incidence study encompassed data from Swedish registers (2006–2018). Patients aged 5–30 years were exposed to one or more psychotropic medications (attention deficit hyperactivity disorder medications, antihistamines, selective serotonin reuptake inhibitors, other antidepressants, anxiolytics, antipsychotics, hypnotics/sedatives). Annual incidences, trends, and mean incidences of cardiac events (cardiac arrest, arrhythmias, fainting/collapse, sudden death) and recurrent events were calculated. Results: Among those exposed (n=875,430, 2,647,957 patient-years, 55% female), 26,750 cardiac events were identified. The mean annual incidence of cardiac events and first-ever events were 0.98% and 0.80%, respectively, showing significant upward annual trends of 4.26% and 2.48%, respectively (p<0.001). The highest incidences were among females aged 15–19 years (1.50%) and those exposed to polypharmacy (1.63%), anxiolytics (1.53%), or antihistamines (1.27%). The mean annual incidences of cardiac arrest and arrythmias, for both sexes, were 0.01% and 0.51%, respectively. Fainting/collapse accounted for about half of all events, occurring more often in females. The pattern of rising annual incidence remained after excluding fainting/collapse. In all, 21.1% of events were recurrent. Sudden death occurred in thirteen patients. Conclusions: The mean annual incidence of cardiac events among young patients receiving psychopharmacological treatment was low, 0.98%, with an upward trend of 4.26% annually. Incidence was highest in females and patients exposed to polypharmacy. Our study highlights the need for more knowledge regarding the possible association between exposure to psychopharmacological treatment and cardiac events.
Submitted to British Journal of Clinical Pharmacology
05 Jun 2024Assigned to Editor
05 Jun 2024Submission Checks Completed
05 Jun 2024Review(s) Completed, Editorial Evaluation Pending
17 Jun 2024Reviewer(s) Assigned
22 Jul 2024Editorial Decision: Revise Major
13 Sep 20241st Revision Received
16 Sep 2024Assigned to Editor
16 Sep 2024Submission Checks Completed
16 Sep 2024Review(s) Completed, Editorial Evaluation Pending
02 Oct 2024Editorial Decision: Accept