Sudden cardiac and sudden unexpected death related to antipsychotics: A meta-analysis of observational studies

To estimate the risk of sudden cardiac death (SCD) or sudden unexpected death (SUD) related to individual antipsychotics, a meta-analysis of observational studies was performed. Adjusted odds ratio (OR) of SCD/SUD with 95% confidence intervals (CI) were extracted and pooled; heterogeneity was studied using Q statistic and I 2 index, and its potential causes (e.g., hERG blockade potency) explored using meta-regression. Two cohort and four case-control studies, investigating nine antipsychotics, were included. Compared with nonusers, the risk was increased for quetiapine, olanzapine, risperidone, haloperidol, clozapine, and thioridazine. Heterogeneity was found, and the increasing mean hERG blockade potency accounted for 43% of this. The SCD/SUD risk differed between individual antipsychotics, and mean hERG blockade potency could be an explanatory factor. This should be considered when initiating antipsychotic treatment.

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