title: Incidence and risk factors for clozapine-induced myocarditis and cardiomyopathy at a regional mental health service in Australia.
abstract: OBJECTIVE
  To determine the incidence of clozapine-induced myocarditis and cardiomyopathy and identify risk factors.
  
  
  METHODS
  A cohort of 129 patients initiated on clozapine at Toowoomba Mental Health Service from year 2000 until 2011 was examined to evaluate cases of myocarditis and cardiomyopathy. Risk factors were analysed using multivariable logistic regression.
  
  
  RESULTS
  The incidence of clozapine-induced myocarditis and cardiomyopathy was 3.88% and 4.65% (or 2.26 per 100 patient years), respectively. A significant association was identified between clozapine-induced myocarditis and SSRI use (p = 0.043). Subclinical cardiomyopathy was identified in the absence of symptoms in the majority of cases.
  
  
  CONCLUSIONS
  These results illustrate a high incidence of clozapine-induced myocarditis as well as cardiomyopathy, reinforcing the need for a standardised, mandatory monitoring scheme. Concomitant SSRI use as one such potential predictor merits further study.
authors.affiliation: Honours Researcher, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia; RMO, Royal Brisbane and Women's Hospital, Herston, QLD, Australia daniel.youssef@health.qld.gov.au.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Youssef
authors.affiliation: Consultant Cardiologist, Toowoomba Hospital, Toowoomba, QLD, Australia.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Narayanan
authors.affiliation: Associate Professor of Rural Psychiatry, Rural Clinical School, University of Queensland, Toowoomba, QLD, and; Medical Director, Adult and Older Persons Mental Health, Gold Coast Health, Gold Coast, QLD, Australia.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects; D001315:Australia / Q000453:epidemiology; D009202:Cardiomyopathies / Q000139:chemically induced / Q000453:epidemiology*; D003024:Clozapine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D009205:Myocarditis / Q000139:chemically induced / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: cardiomyopathy; clozapine; incidence; myocarditis; risk factors