Severe mental illness (SMI) has considerable excess morbidity and mortality, a proportion of which is explained by cardiovascular diseases, caused in part by antipsychotic (AP) induced QT-related arrhythmias and sudden death by Torsade de Point (TdP). The implementation of evidence-based recommendations for cardiac function monitoring might reduce the incidence of these AP-related adverse events. To investigate clinicians’ adherence to cardiac function monitoring before and after starting AP, we performed a retrospective assessment of 434 AP-treated SMI patients longitudinally followed-up for 5 years at an academic community mental health center.
We classified antipsychotics according to their risk of inducing QT-related arrhythmias and TdP (Center for Research on Therapeutics, University of Arizona). We used univariate tests and multinomial or binary logistic regression model for data analysis.
Univariate and multinomial regression analysis showed that psychiatrists were more likely to perform pre-treatment electrocardiogram (ECG) and electrolyte testing with AP carrying higher cardiovascular risk, but not on the basis of AP pharmacological class. Univariate and binomial regression analysis showed that cardiac function parameters (ECG and electrolyte balance) were more frequently monitored during treatment with second generation AP than with first generation AP.
Our data show the presence of weaknesses in the cardiac function monitoring of AP-treated SMI patients, and might guide future interventions to tackle them.
Kooy FH. Hyperglycemia in mental disorders. Brain. 1919;42:214–88. CrossRef
Raphael T, Parsons JP. Blood sugar studies in dementia praecox and manic-depressive insanity. Arch Neurol Psychiatr. 1921;5:687–709. CrossRef
De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011;10:138–51. CrossRefPubMedPubMedCentral
Brunton L, Chabner BA, Knollmann BC. Goodman and Gilman's the pharmacological basis of Therapeutics. Twelfth ed. New York (NY): McGraw-Hill; 2011.
Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: amultiple-treatments meta-analysis. Lancet. 2013;382:951–62.
Rampe D, Murawsky MK, Grau J, Lewis EW. The antipsychotic agent sertindole is a high affinity antagonist of the human cardiac potassium channel HERG. J Pharmacol Exp Ther. 1998;286:788–93. PubMed
Woosley RL, Romero KA: http://www.crediblemeds.org/, QTdrug List. AZCERT, Inc 2015, 1822 Innovation Park Dr., Oro Valley, AZ 85755.
NICE. Psychosis and schizophrenia in adults: prevention and management. https://www.nice.org.uk/guidance/cg178. 2014.
American Psychiatric Association: American Psychiatric Association: diagnostic and statistical manual of mental disorders (4th ed., text rev.), 1st edn. Washington, DC: American Psychiatri Association; 2000.
Abdelmawla N, Mitchell AJ. Sudden cardiac death and antipsychotics part 2: monitoring and prevention. Adv Psychiatr Treat. 2006;12:100–9. CrossRef
Darwiche FZ, Ugradar ST, Turner T. Junior doctors’ knowledge and practice of electrocardiographic monitoring for high-risk patients receiving antipsychotic medications. Psychiatr Bull. 2009;33:377–80. CrossRef
Osborn DP, Baio G, Walters K, Petersen I, Limburg H, Raine R, et al. Inequalities in the provision of cardiovascular screening to people with severe mental illnesses in primary care: cohort study in the United Kingdom THIN primary care database 2000-2007. Schizophr Res. 2011;129:104–10. CrossRefPubMed
Jones WR, Narayana U, Howarth S, Shinners J, Nazar Q. Cardiovascular monitoring in patients prescribed clozapine. Psychiatr Bull (2014). 2014;38:140. CrossRef
- Clinicians’ adherence to clinical practice guidelines for cardiac function monitoring during antipsychotic treatment: a retrospective report on 434 patients with severe mental illness
- BioMed Central
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