Adverse cardiac events in out‐patients initiating clozapine treatment: a nationwide register‐based study. (24th October 2017)

• Record Type: Journal Article
• Authors: Rohde, C.; Polcwiartek, C.; Kragholm, K.; Ebdrup, B. H.; Siskind, D.; Nielsen, J.
• Is Part Of: Acta psychiatrica Scandinavica. Volume 137:Number 1(2018)
• Page Start: 47
• Page End: 53
• Publication Date: 2017-10-24
• Subjects: myocarditis -- pericarditis -- cardiomyopathy -- clozapine -- antipsychotics -- mortality -- Danish nationwide registers; Psychiatry -- Periodicals; 616.89
• DOI: 10.1111/acps.12827
• Languages: English
• ISSNs: 0001-690X

Abstract

Abstract : Objective: Using national Danish registers, we estimated rates of clozapine‐associated cardiac adverse events. Rates of undiagnosed myocarditis were estimated by exploring causes of death after clozapine initiation. Method: Through nationwide health registers, we identified all out‐patients initiating antipsychotic treatment (January 1, 1996–January 1, 2015). Rates of clozapine‐associated myocarditis and pericarditis within 2 months from clozapine initiation and rates of cardiomyopathy within 1–2 years from clozapine initiation were compared to rates for other antipsychotics. Mortality within 2 months from clozapine initiation was extracted. Results: Three thousand two hundred and sixty‐two patients of a total 7932 patients initiated clozapine as out‐patients (41.12%). One patient (0.03%) developed myocarditis, and no patients developed pericarditis within 2 months from clozapine initiation. Two (0.06%) and four patients (0.12%) developed cardiomyopathy within 1 and 2 years respectively. Rates were similar for other antipsychotics. Twenty‐six patients died within 2 months from clozapine initiation. Pneumonia (23.08%) and stroke (11.54%) were the main causes of death. We estimated the maximum rate of clozapine‐associated fatal myocarditis to 0.28%. Conclusion: Cardiac adverse effects in Danish out‐patients initiating clozapine treatment are extremely rare and these rates appear to be comparable to those observed for other antipsychotic drugs.