title: Haloperidol and sudden cardiac death in dementia: autopsy findings in psychiatric inpatients.
abstract: OBJECTIVE
  Treatment with haloperidol has been shown, in studies using death certificates and prescription files, to be associated with an excess of sudden cardiac deaths, and regulatory warnings highlight this risk in patients with dementia. We used autopsy findings to determine whether the rate of sudden cardiac death is greater in cases of unexpected deaths of patients with dementia treated with haloperidol.
  
  
  METHODS
  From 1989 through 2013, 1219 patients with a primary diagnosis of dementia with behavioral disturbance were admitted to a psychiatric hospital, and 65 (5.3%) died suddenly. Sixty-five patients (5.3%) died unexpectedly. Complete post-mortem examinations after the sudden death were performed in 55 (84.6%) patients. Twenty-seven of the autopsied cases (49.1%) had been treated with haloperidol orally (2.2 mg ± 2.1 mg/day), the only antipsychotic used in this cohort. Univariable comparisons and multivariable regression analyses compared the groups of patients with or without sudden cardiac death.
  
  
  RESULTS
  The leading causes of death were sudden cardiac death (32.7%), myocardial infarction (25.5% of patients), pneumonia (23.6%), and stroke (10.9%). Patients with sudden cardiac death and those with anatomically established cause of death were similar regarding the use of haloperidol (p = 0.5). Sudden cardiac death patients were more likely to suffer from Alzheimer's dementia (p = 0.027) and to have a past history of heart disease (p = 0.0094), and less likely to have been treated with a mood stabilizer (p = 0.024), but none of these variables were independent predictors of sudden cardiac death.
  
  
  CONCLUSIONS
  Autopsy data suggest that oral haloperidol is not associated with increased risk of sudden cardiac death in psychiatric inpatients with dementia.
authors: Faculty of Medicine, Transilvania University, Brasov, Romania.
authors: Petru
authors: P
authors: Ifteni
authors: The Zucker Hillside Hospital, Glen Oaks, NY, USA.
authors: Eugene
authors: E
authors: Grudnikoff
authors: Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, USA.|The Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Manhasset, NY, USA.|The Feinstein Institute for Medical Research, Manhasset, NY, USA.
authors: Jeremy
authors: J
authors: Koppel
authors: The Zucker Hillside Hospital, Glen Oaks, NY, USA.|Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, USA.
authors: Neil
authors: N
authors: Kremen
authors: The Zucker Hillside Hospital, Glen Oaks, NY, USA.|Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, USA.|The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Christoph U
authors: CU
authors: Correll
authors: The Zucker Hillside Hospital, Glen Oaks, NY, USA.|Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, USA.|The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Albert Einstein College of Medicine, Bronx, NY, USA.
authors: John M
authors: JM
authors: Kane
authors: The Zucker Hillside Hospital, Glen Oaks, NY, USA.|Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, USA.|Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Peter
authors: P
authors: Manu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001344:Autopsy; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D003704:Dementia / Q000188:drug therapy; D005260:Female; D006220:Haloperidol / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol
keywords: Death; Dementia; Haloperidol; Unexpected