Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy

A. Biffi, F. Rea, L. Scotti, A. Mugelli, E. Lucenteforte, A. Bettiol, A. Chinellato, G. Onder, C. Vitale, N. Agabiti, G. Trifiro, G. Roberto, G. Corrao, Italian Group for Appropriate Drug prescription in the Elderly (I-GrADE)

Research output: Contribution to journalArticle

Abstract

PURPOSE: The study aimed to fill existing knowledge gaps on the safety of antidepressant drugs (ADs) by estimating the risk of hospitalization for arrhythmia associated with use of selective serotonin reuptake inhibitors (SSRIs) and newer atypical ADs (NAAs) among elderly with previous cardiovascular (CV) events. METHODS: The cohort was composed by 199,569 individuals aged >/= 65 years from five Italian healthcare territorial units who were discharged for cardiovascular outcomes in the years 2008-2010. The 17,277 patients who experienced hospital admission for arrhythmia during follow-up were included as cases. Odds of current ADs use among cases (i.e., 14 days before hospital admission) was compared with (i) odds of current use of 1:5 matched controls (between-patients case-control) and with (ii) odds of previous use during 1:5 matched control periods (within-patient case-crossover). The risk of arrhythmia associated with ADs current use was modelled fitting a conditional logistic regression. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS: Current users of SSRIs and NAAs were at increased risk of arrhythmia with case-control odds ratios (OR) of 1.37 (95% confidence interval, CI 1.18 to 1.58) and 1.41 (1.16 to 1.71) and case-crossover OR of 1.48 (1.20 to 1.81) and 1.72 (1.31 to 2.27). An increased risk of arrhythmia was associated with current use of trazodone (NAA) consistently in case-control and case-crossover designs. CONCLUSIONS: Evidence that current use of SSRIs and NAAs is associated to an increased risk of arrhythmia among elderly with CV disease was consistently supplied by two observational approaches.
Original languageEnglish
Pages (from-to)119-129
Number of pages11
JournalEuropean Journal of Clinical Pharmacology
Volume74
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

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Italy
Antidepressive Agents
Cardiac Arrhythmias
Cardiovascular Diseases
Serotonin Uptake Inhibitors
Second-Generation Antidepressive Agents
Odds Ratio
Trazodone
Cross-Over Studies
Uncertainty
Hospitalization
Logistic Models
Confidence Intervals
Delivery of Health Care
Safety

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Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy. / Biffi, A.; Rea, F.; Scotti, L.; Mugelli, A.; Lucenteforte, E.; Bettiol, A.; Chinellato, A.; Onder, G.; Vitale, C.; Agabiti, N.; Trifiro, G.; Roberto, G.; Corrao, G.; (I-GrADE), Italian Group for Appropriate Drug prescription in the Elderly.

In: European Journal of Clinical Pharmacology, Vol. 74, No. 1, 01.01.2018, p. 119-129.

Research output: Contribution to journalArticle

Biffi, A, Rea, F, Scotti, L, Mugelli, A, Lucenteforte, E, Bettiol, A, Chinellato, A, Onder, G, Vitale, C, Agabiti, N, Trifiro, G, Roberto, G, Corrao, G & (I-GrADE), IGFADPITE 2018, 'Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy', European Journal of Clinical Pharmacology, vol. 74, no. 1, pp. 119-129. https://doi.org/10.1007/s00228-017-2352-x [doi]
Biffi, A. ; Rea, F. ; Scotti, L. ; Mugelli, A. ; Lucenteforte, E. ; Bettiol, A. ; Chinellato, A. ; Onder, G. ; Vitale, C. ; Agabiti, N. ; Trifiro, G. ; Roberto, G. ; Corrao, G. ; (I-GrADE), Italian Group for Appropriate Drug prescription in the Elderly. / Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy. In: European Journal of Clinical Pharmacology. 2018 ; Vol. 74, No. 1. pp. 119-129.
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T1 - Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy

AU - Biffi, A.

AU - Rea, F.

AU - Scotti, L.

AU - Mugelli, A.

AU - Lucenteforte, E.

AU - Bettiol, A.

AU - Chinellato, A.

AU - Onder, G.

AU - Vitale, C.

AU - Agabiti, N.

AU - Trifiro, G.

AU - Roberto, G.

AU - Corrao, G.

AU - (I-GrADE), Italian Group for Appropriate Drug prescription in the Elderly

N1 - LR: 20181113; GR: FARM9LBBBL/AIFA project; JID: 1256165; 0 (Antidepressive Agents); OTO: NOTNLM; 2017/08/04 00:00 [received]; 2017/10/09 00:00 [accepted]; 2017/10/20 06:00 [pubmed]; 2018/07/26 06:00 [medline]; 2017/10/20 06:00 [entrez]; ppublish

PY - 2018/1/1

Y1 - 2018/1/1

N2 - PURPOSE: The study aimed to fill existing knowledge gaps on the safety of antidepressant drugs (ADs) by estimating the risk of hospitalization for arrhythmia associated with use of selective serotonin reuptake inhibitors (SSRIs) and newer atypical ADs (NAAs) among elderly with previous cardiovascular (CV) events. METHODS: The cohort was composed by 199,569 individuals aged >/= 65 years from five Italian healthcare territorial units who were discharged for cardiovascular outcomes in the years 2008-2010. The 17,277 patients who experienced hospital admission for arrhythmia during follow-up were included as cases. Odds of current ADs use among cases (i.e., 14 days before hospital admission) was compared with (i) odds of current use of 1:5 matched controls (between-patients case-control) and with (ii) odds of previous use during 1:5 matched control periods (within-patient case-crossover). The risk of arrhythmia associated with ADs current use was modelled fitting a conditional logistic regression. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS: Current users of SSRIs and NAAs were at increased risk of arrhythmia with case-control odds ratios (OR) of 1.37 (95% confidence interval, CI 1.18 to 1.58) and 1.41 (1.16 to 1.71) and case-crossover OR of 1.48 (1.20 to 1.81) and 1.72 (1.31 to 2.27). An increased risk of arrhythmia was associated with current use of trazodone (NAA) consistently in case-control and case-crossover designs. CONCLUSIONS: Evidence that current use of SSRIs and NAAs is associated to an increased risk of arrhythmia among elderly with CV disease was consistently supplied by two observational approaches.

AB - PURPOSE: The study aimed to fill existing knowledge gaps on the safety of antidepressant drugs (ADs) by estimating the risk of hospitalization for arrhythmia associated with use of selective serotonin reuptake inhibitors (SSRIs) and newer atypical ADs (NAAs) among elderly with previous cardiovascular (CV) events. METHODS: The cohort was composed by 199,569 individuals aged >/= 65 years from five Italian healthcare territorial units who were discharged for cardiovascular outcomes in the years 2008-2010. The 17,277 patients who experienced hospital admission for arrhythmia during follow-up were included as cases. Odds of current ADs use among cases (i.e., 14 days before hospital admission) was compared with (i) odds of current use of 1:5 matched controls (between-patients case-control) and with (ii) odds of previous use during 1:5 matched control periods (within-patient case-crossover). The risk of arrhythmia associated with ADs current use was modelled fitting a conditional logistic regression. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS: Current users of SSRIs and NAAs were at increased risk of arrhythmia with case-control odds ratios (OR) of 1.37 (95% confidence interval, CI 1.18 to 1.58) and 1.41 (1.16 to 1.71) and case-crossover OR of 1.48 (1.20 to 1.81) and 1.72 (1.31 to 2.27). An increased risk of arrhythmia was associated with current use of trazodone (NAA) consistently in case-control and case-crossover designs. CONCLUSIONS: Evidence that current use of SSRIs and NAAs is associated to an increased risk of arrhythmia among elderly with CV disease was consistently supplied by two observational approaches.

U2 - 10.1007/s00228-017-2352-x [doi]

DO - 10.1007/s00228-017-2352-x [doi]

M3 - Article

VL - 74

SP - 119

EP - 129

JO - European Journal of Clinical Pharmacology

JF - European Journal of Clinical Pharmacology

SN - 0031-6970

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