Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are medications offered to treat a variety of anxiety disorders. Some studies found a link between SSRI/SNRI use and increased risks of abnormal heart rhythm and death. But stopping those treatments, or reducing their dose, doesn’t weigh mental health benefits for the patient against potential heart risks.
The aim of this study is to better understand the relationship between SSRI/SNRI use and the risk for heart health. We will focus on the risks of heart attack, stroke, heart rhythm modifications, and death. We will also look at whether taking multiple SSRI(s)/SNRI(s) is linked to a greater risk of heart issues.
To do so, we will use data from the Clinical Practice Research Datalink (CPRD). We will analyse anonymized electronic medical records from general practices and hospitals, and anonymized death records, of adult patients who received a diagnosis for an anxiety disorder. A group of patients taking SSRI(s) and/or SNRI(s) will be compared to another group of patients not taking those medications. We will then compare the amount of recorded heart issues and deaths between the two groups. Our analyses will also include known risk factors such as sex, age, smoking and other health conditions.
This study will provide further information whether there is a link between SSRI/SNRI use and risks of heart issues and death. This will provide important information to physicians and patients for the management of anxiety disorders using medications.
Selective serotonin reuptake inhibitor/selective serotonin and norepinephrine reuptake inhibitor (SSRI/SNRI) use has been associated with serious cardiac adverse events, including lethal ventricular arrhythmia torsades de pointes. Further research is needed to address SSRI/SNRI cardiac safety. Our study will investigate the impact of SSRI/SNRI use in patients with an anxiety disorder on cardiovascular mortality, myocardial infarction, stroke, ventricular tachycardia and total mortality, controlling for relevant confounding. Patients exposed to SSRI/SNRI will be compared to non-exposed patients.
Our retrospective cohort study will include at least 10,000 adults who received an anxiety disorder diagnosis between 1st January 2010 and 31st December 2010. Outcomes will be recorded up until 31st December 2019. Linked CPRD primary care data, Hospital Episode Statistics data (HES), and Office for National Statistics (ONS) Death Registration data will be analyzed.
The outcomes will be myocardial infarction, stroke, ventricular tachycardia, all-cause cardiac mortality, and total mortality. ICD-9 and ICD-10 codes will be used to identify diagnoses in HES and primary care datasets, while mortality data will be retrieved from the ONS dataset.
Confounding factors such as demographic characteristics, smoking, comorbidities and use of other drugs, will be accounted for. Baseline characteristics and the incidence of cardiac comorbidities and deaths will be summarised. The relative risk of all study outcomes will be estimated with the hazard ratio (HR) from Cox proportional hazards regression models, with SSRI/SNRI use as a time-dependent covariate. HRs will be adjusted for confounders.
All-cause cardiac mortality; Myocardial infarction; Stroke; Ventricular tachycardia; All-cause mortality
Judith Brouillette - Chief Investigator - Montreal Heart Institute
Samuel Cyr - Corresponding Applicant - Montreal Heart Institute
Christel Renoux - Collaborator - McGill University
Marie-Claude Guertin - Collaborator - Montreal Heart Institute
Michelle Samuel - Collaborator - Montreal Heart Institute
Paul Khairy - Collaborator - Montreal Heart Institute
Rafik Tadros - Collaborator - Montreal Heart Institute
HES Admitted Patient Care;ONS Death Registration Data