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.

Objectives: This study aimed to map prescription patterns of pulmonary vasodilator therapy in children with bronchopulmonary dysplasia (BPD). Working hypothesis: Pulmonary vasodilator drug therapy is used in children born preterm suffering from BPD-associated pulmonary hypertension, but patient selection, extent of diagnostics with catheterization and co-morbidities are largely unknown. Study design: A descriptive national registry-based study. Patient selection and methodology: All children below seven years of age who had been prescribed a pulmonary vasodilator during a ten-year period, 2007-2017, born preterm (gestational age, GA <37 weeks) and classified as BPD, were included. Information on prescriptions was retrieved from the Swedish Prescribed Drug Register and information on patient characteristics and comorbidities was retrieved by linkage to national registers held by the National Board of Health and Welfare. Results: In total, 74 children were included, 54 (73%) born at GA 22-27 and 20 (27%) at GA 28-36. Single therapy was most common, N=64 (86.5%), and sildenafil was most frequently prescribed, N=69 (93%). Bosentan, iloprost, macitentan and/or treprostinil were mainly used for combination therapies, N=10 (13.5%). Patent ductus arteriosus (PDA) or atrial septal defect (ASD) was present in N=29 (39%) and N=25 (34%) children respectively, and N=20 (69%) versus N=3 (12%) underwent closure. Cardiac catheterization was performed in N=19 (26%) patients. Median duration of therapy was 4.4 (0.5-14.1, 95% percentiles) months. Total mortality was N=7 (9%). Conclusions: Preterm children with BPD are prescribed pulmonary vasodilators, often without prior catheterization and sildenafil was most common. Diagnostic tools, effects, and drug safety needs further evaluation.