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Title: Hearts and Minds: Real-Life Cardiotoxicity With Clozapine in Psychosis.
Authors: Joy, George
Whiskey, Eromona
Bolstridge, Mark
Porras-Segovia, Alejandro
McDonagh, Theresa A
Plymen, Carla M
Shergill, Sukhi S
metadata.dc.subject.mesh: Adult
Antipsychotic Agents
Follow-Up Studies
Middle Aged
Retrospective Studies
Ventricular Dysfunction, Left
Issue Date: 2017
Abstract: Schizophrenia has a 1% prevalence in the population; 30% of these patients are treatment refractory. Clozapine is the only drug licensed to treat treatment refractory psychosis, but concerns about potential adverse effects result in only a proportion of eligible patients being treated. Although a well-documented neutropenia risk is mitigated by routine blood testing, cardiac toxicity is a commonly cited reason to discontinue clozapine treatment. However, there is little data on the real-life cardiac outcomes in those receiving clozapine treatment. Retrospective review of electrocardiogram, echocardiogram, and clinical outcomes in 39 inpatients with treatment-refractory schizophrenia, treated with clozapine and other antipsychotic medication, referred for cardiology opinion. Commonest reasons for referral were development of left ventricular (LV) impairment or sinus tachycardia with normal LV function. Patients were reviewed by a range of cardiologists, receiving varied interventions.Median LV ejection fraction in the clozapine group was normal (52%). Serial echocardiograms demonstrated that clozapine-treated patients with LV impairment had no change in LV ejection fraction over a 4-month follow-up. Left ventricular ejection fraction did not differ between patients treated with clozapine and other antipsychotics. However, over an 11-year follow-up period, 48% of patients had discontinued clozapine treatment. This naturalistic study demonstrates that clozapine is not associated with significant cardiac mortality or morbidity. There is a real need for multidisciplinary working between specialist cardiologists and psychiatrists caring for these complex patients to facilitate optimal long-term physical and mental health outcomes.
metadata.dc.identifier.doi: 10.1097/JCP.0000000000000792
Appears in Collections:Producción 2020

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