title: Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults - a Swedish nationwide study.
abstract: OBJECTIVE
  The aim of the study was to examine mortality risk associated with use of antidepressants and antipsychotics classified with torsades de pointes (TdP) risk in elderly.
  
  
  METHODS
  A matched case-control register study was conducted in people 65 years and older dying outside hospital from 2008-2013 (n = 286,092) and matched controls (n = 1,430,460). The association between prescription of antidepressants and antipsychotics with various TdP risk according to CredibleMeds (www.crediblemeds.org) and all-cause mortality was studied by multivariate conditional logistic regression adjusted for comorbidity and several other confounders.
  
  
  RESULTS
  Use of antidepressants classified with known or possible TdP risk, was associated with higher adjusted risk for mortality (OR 1.53, 95% CI 1.51, 1.56 and OR 1.63, 95% CI 1.61, 1.67, respectively) compared with antidepressants classified with conditional TdP risk (OR 1.25, 95% CI 1.22, 1.28) or without TdP classification (OR 0.99, 95% CI 0.94, 1.05). Antipsychotics classified with known TdP risk were associated with higher risk (OR 4.57, 95% CI 4.37, 4.78) than antipsychotics with possible risk (OR 2.58, 95% CI 2.52, 2.64) or without TdP classification (OR 2.14, 95% CI 2.03, 2.65). The following risk ranking was observed for commonly used antidepressants: mirtazapine > citalopram > sertraline > amitriptyline and for antipsychotics: haloperidol > risperidone >olanzapine > quetiapine.
  
  
  CONCLUSIONS
  The CredibleMeds system predicted drug-associated risk for mortality in the elderly at the risk class level. Among antipsychotics, haloperidol, and among antidepressants, mirtazapine and citalopram, were associated with the highest risks. The results suggest that the TdP risk with antidepressants and antipsychotics should be taken into consideration when prescribing to the elderly.
authors.affiliation: Department of Analysis and Evaluation, National Board of Health and Welfare (Socialstyrelsen), 106 30, Stockholm.
authors.forename: Bengt
authors.initials: B
authors.lastname: Danielsson
authors.affiliation: Department of Analysis and Evaluation, National Board of Health and Welfare (Socialstyrelsen), 106 30, Stockholm.
authors.forename: Julius
authors.initials: J
authors.lastname: Collin
authors.affiliation: Department of Analysis and Evaluation, National Board of Health and Welfare (Socialstyrelsen), 106 30, Stockholm.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Jonasdottir Bergman
authors.affiliation: Department of Analysis and Evaluation, National Board of Health and Welfare (Socialstyrelsen), 106 30, Stockholm.
authors.forename: Natalia
authors.initials: N
authors.lastname: Borg
authors.affiliation: Department of Analysis and Evaluation, National Board of Health and Welfare (Socialstyrelsen), 106 30, Stockholm.
authors.forename: Peter
authors.initials: P
authors.lastname: Salmi
authors.affiliation: Department of Analysis and Evaluation, National Board of Health and Welfare (Socialstyrelsen), 106 30, Stockholm.|Aging Research Center, Karolinska Institutet and Stockholm University, Gävlegatan 16, 113 30, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Fastbom
mesh_terms: D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000145:classification / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000145:classification / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D012042:Registries; D012306:Risk; D013548:Sweden / Q000453:epidemiology; D016171:Torsades de Pointes / Q000139:chemically induced / Q000401:mortality*
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: all-cause mortality; antidepressants; antipsychotics; elderly; torsades de pointes