Sudden Cardiac Death: Pharmacotherapy and Proarrhythmic Drugs: A Nationwide Cohort Study in Denmark

Bjarke Risgaard; Bo Gregers Winkel; Reza Jabbari; Thomas Hadberg Lynge; Mads Wissenberg; Charlotte Glinge; Stig Haunsø; Elijah R Behr; Anders Fink-Jensen; Gunnar Hilmar Gislason; Jacob Tfelt-Hansen

doi:10.1016/j.jacep.2016.12.023

Sudden Cardiac Death: Pharmacotherapy and Proarrhythmic Drugs: A Nationwide Cohort Study in Denmark

Bjarke Risgaard^*, Bo Gregers Winkel, Reza Jabbari, Thomas Hadberg Lynge, Mads Wissenberg, Charlotte Glinge, Stig Haunsø, Elijah R Behr, Anders Fink-Jensen, Gunnar Hilmar Gislason, Jacob Tfelt-Hansen

^*Corresponding author af dette arbejde

12 Citationer (Scopus)

Abstract

Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how pharmacotherapy may contribute to the overall burden of SCD in the general population. Methods This was a nationwide study that included all deaths that occurred between 2000 and 2009 and between 2007 and 2009 in people age 1 to 35 years and 36 to 49 years, respectively. Two physicians identified all SCDs through review of death certificates. Autopsy reports were collected. Pharmacotherapy prescribed within 90 days before SCD was identified in the Danish Registry of Medicinal Product Statistics. Results We identified 1,363 SCDs; median age was 38 years (interquartile range: 29 to 45 years), and 72% (n = 975) were men. Autopsy was performed in 55%. Overall, 58% of SCD cases (n = 786) received at least 1 drug within 90 days before death. The most common drugs were analgesic drugs (n = 239; 18%), antihypertensive drugs (n = 234; 17%), and antibiotic drugs (n = 218; 16%). After multivariable adjustment, prescription of “brugadogenic” drugs or >1 QT-prolonging drug was associated with an increased risk of SADS compared with explained SCD (odds ratio: 2.16 [95% confidence interval: 1.12 to 4.17] and 2.91 [95% confidence interval: 1.46 to 5.81], respectively). Conclusions Pharmacotherapy was identified in 58% of the SCD cases. After multivariable adjustment, there was a 2- and 3-fold increased risk of SADS compared with explained SCD in patients receiving brugadogenic drugs or >1 QT-prolonging drug, respectively. Identification of high-risk patients is warranted to lower the burden of SCD.

Originalsprog	Engelsk
Tidsskrift	JACC: Clinical Electrophysiology
Vol/bind	3
Udgave nummer	5
Sider (fra-til)	473-481
Antal sider	9
ISSN	2405-500X
DOI	https://doi.org/10.1016/j.jacep.2016.12.023
Status	Udgivet - 1 maj 2017

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10.1016/j.jacep.2016.12.023

Citationsformater

@article{51c9229cdebe402a8ec1398614e47da3,

title = "Sudden Cardiac Death: Pharmacotherapy and Proarrhythmic Drugs: A Nationwide Cohort Study in Denmark",

abstract = "Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how pharmacotherapy may contribute to the overall burden of SCD in the general population. Methods This was a nationwide study that included all deaths that occurred between 2000 and 2009 and between 2007 and 2009 in people age 1 to 35 years and 36 to 49 years, respectively. Two physicians identified all SCDs through review of death certificates. Autopsy reports were collected. Pharmacotherapy prescribed within 90 days before SCD was identified in the Danish Registry of Medicinal Product Statistics. Results We identified 1,363 SCDs; median age was 38 years (interquartile range: 29 to 45 years), and 72% (n = 975) were men. Autopsy was performed in 55%. Overall, 58% of SCD cases (n = 786) received at least 1 drug within 90 days before death. The most common drugs were analgesic drugs (n = 239; 18%), antihypertensive drugs (n = 234; 17%), and antibiotic drugs (n = 218; 16%). After multivariable adjustment, prescription of “brugadogenic” drugs or >1 QT-prolonging drug was associated with an increased risk of SADS compared with explained SCD (odds ratio: 2.16 [95% confidence interval: 1.12 to 4.17] and 2.91 [95% confidence interval: 1.46 to 5.81], respectively). Conclusions Pharmacotherapy was identified in 58% of the SCD cases. After multivariable adjustment, there was a 2- and 3-fold increased risk of SADS compared with explained SCD in patients receiving brugadogenic drugs or >1 QT-prolonging drug, respectively. Identification of high-risk patients is warranted to lower the burden of SCD.",

keywords = "drugs, pharmacotherapy, sudden arrhythmic death, sudden cardiac death",

author = "Bjarke Risgaard and Winkel, {Bo Gregers} and Reza Jabbari and Lynge, {Thomas Hadberg} and Mads Wissenberg and Charlotte Glinge and Stig Hauns{\o} and Behr, {Elijah R} and Anders Fink-Jensen and Gislason, {Gunnar Hilmar} and Jacob Tfelt-Hansen",

year = "2017",

month = may,

day = "1",

doi = "10.1016/j.jacep.2016.12.023",

language = "English",

volume = "3",

pages = "473--481",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-5018",

publisher = "Elsevier USA",

number = "5",

}

TY - JOUR

T1 - Sudden Cardiac Death

T2 - Pharmacotherapy and Proarrhythmic Drugs: A Nationwide Cohort Study in Denmark

AU - Risgaard, Bjarke

AU - Winkel, Bo Gregers

AU - Jabbari, Reza

AU - Lynge, Thomas Hadberg

AU - Wissenberg, Mads

AU - Glinge, Charlotte

AU - Haunsø, Stig

AU - Behr, Elijah R

AU - Fink-Jensen, Anders

AU - Gislason, Gunnar Hilmar

AU - Tfelt-Hansen, Jacob

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how pharmacotherapy may contribute to the overall burden of SCD in the general population. Methods This was a nationwide study that included all deaths that occurred between 2000 and 2009 and between 2007 and 2009 in people age 1 to 35 years and 36 to 49 years, respectively. Two physicians identified all SCDs through review of death certificates. Autopsy reports were collected. Pharmacotherapy prescribed within 90 days before SCD was identified in the Danish Registry of Medicinal Product Statistics. Results We identified 1,363 SCDs; median age was 38 years (interquartile range: 29 to 45 years), and 72% (n = 975) were men. Autopsy was performed in 55%. Overall, 58% of SCD cases (n = 786) received at least 1 drug within 90 days before death. The most common drugs were analgesic drugs (n = 239; 18%), antihypertensive drugs (n = 234; 17%), and antibiotic drugs (n = 218; 16%). After multivariable adjustment, prescription of “brugadogenic” drugs or >1 QT-prolonging drug was associated with an increased risk of SADS compared with explained SCD (odds ratio: 2.16 [95% confidence interval: 1.12 to 4.17] and 2.91 [95% confidence interval: 1.46 to 5.81], respectively). Conclusions Pharmacotherapy was identified in 58% of the SCD cases. After multivariable adjustment, there was a 2- and 3-fold increased risk of SADS compared with explained SCD in patients receiving brugadogenic drugs or >1 QT-prolonging drug, respectively. Identification of high-risk patients is warranted to lower the burden of SCD.

AB - Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how pharmacotherapy may contribute to the overall burden of SCD in the general population. Methods This was a nationwide study that included all deaths that occurred between 2000 and 2009 and between 2007 and 2009 in people age 1 to 35 years and 36 to 49 years, respectively. Two physicians identified all SCDs through review of death certificates. Autopsy reports were collected. Pharmacotherapy prescribed within 90 days before SCD was identified in the Danish Registry of Medicinal Product Statistics. Results We identified 1,363 SCDs; median age was 38 years (interquartile range: 29 to 45 years), and 72% (n = 975) were men. Autopsy was performed in 55%. Overall, 58% of SCD cases (n = 786) received at least 1 drug within 90 days before death. The most common drugs were analgesic drugs (n = 239; 18%), antihypertensive drugs (n = 234; 17%), and antibiotic drugs (n = 218; 16%). After multivariable adjustment, prescription of “brugadogenic” drugs or >1 QT-prolonging drug was associated with an increased risk of SADS compared with explained SCD (odds ratio: 2.16 [95% confidence interval: 1.12 to 4.17] and 2.91 [95% confidence interval: 1.46 to 5.81], respectively). Conclusions Pharmacotherapy was identified in 58% of the SCD cases. After multivariable adjustment, there was a 2- and 3-fold increased risk of SADS compared with explained SCD in patients receiving brugadogenic drugs or >1 QT-prolonging drug, respectively. Identification of high-risk patients is warranted to lower the burden of SCD.

KW - drugs

KW - pharmacotherapy

KW - sudden arrhythmic death

KW - sudden cardiac death

U2 - 10.1016/j.jacep.2016.12.023

DO - 10.1016/j.jacep.2016.12.023

M3 - Journal article

C2 - 29759603

AN - SCOPUS:85016452148

SN - 2405-5018

VL - 3

SP - 473

EP - 481

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 5

ER -

Sudden Cardiac Death: Pharmacotherapy and Proarrhythmic Drugs: A Nationwide Cohort Study in Denmark

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