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The authors of this retrospective study examined death certificates and autopsy information for 1363 individuals in Denmark who experienced sudden cardiac death (SCD). The study objective was to determine if exposure to specific drug therapy increased risk for SCD. The cohort’s median age at death was 38 years, and 786 (58%) had been exposed to one or more drugs in the 90 days before death. Analgesic, antihypertensive, and antibiotic drugs were the most commonly used in the cohort. Importantly, a higher risk for sudden arrhythmic death syndrome (SADS) was identified with exposure to drugs classed as “brugadogenic” or drugs with QT-prolonging properties than with explained SCD (OR, 2.16 for brugadogenic and 2.91 for QT-prolonging).
The results of this study indicate that “brugadogenic” and QT-prolonging drugs are associated with an increased risk for SADS. The authors recommend better identification of individuals at risk for arrhythmias as a strategy for lowering rates of SCD.
This abstract is available on the publisher's site.
This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD).
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.
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.
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).
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.