In around half of the 350 autopsies carried out every year at the Department of Forensic Medicine at Aarhus University, medications with a special characteristic which are widely used in psychiatry are found. Only in extremely rare cases can the medications be suspected as a cause of death, according to a new study.

2021.11.23 | Jakob Binderup Christensen

 

So-called QT-prolonging medications, which are used in psychiatry in particular, can only be suspected of being the cause of unexpected deaths which are subject to a forensic autopsy in extremely rare cases.

This is the conclusion of a new study carried out by a team of researchers from Aarhus University and the University of Southern Denmark.

"Our objective was to investigate the number of deaths that could be attributed to these medications, due to the fact that there is general caution about using them, as QT-prolongation can cause dangerous heart rhythm disturbances that can lead to sudden unexpected death," says Charlotte Uggerhøj, PhD and clinical associate professor at Aarhus University and medical specialist in clinical pharmacology at Aarhus University Hospital.

She adds:

"However, it turned out that very few deaths could be attributed to the medications."

Primarily used in psychiatry

QT-prolonging medications covers a wide range of medications that affect the repolarisation of the heart – i.e. the interval between the heart contracting and relaxing again.

There are several medications that affect this interval, and the vast majority are used in psychiatry.

These could be medications used to treat depression and psychotic disorders, but they are also found among certain antibiotics and medicine for nausea.

Experience gained from thousands of autopsies was one of the reasons why the researchers were interested in learning more about how dangerous QT-prolonging medications actually are.

Every year, the Department of Forensic Medicine at Aarhus University carries out forensic autopsies on more than 300 deceased persons to ascertain the cause of death. These include sudden and unexpected deaths and a significant proportion of these deaths cover people who have been treated for psychiatric disorders.

741 autopsies

To find out how often a death can be attributed to QT-prolonging medications, the researchers reviewed all autopsies carried out between 2017-2019 – a total of 741.

In 167 of the autopsies, a concentration of QT-prolonging medications was found that was defined as "high-risk".

However, in the vast majority of these cases the researchers were able to exclude the QT-prolonging medications as the cause of death.

There were only seven cases (0.9 percent) in which it was not possible to exclude the QT-prolonging medications as the cause of death.

Many competing causes

According to Charlotte Uggerhøj, the number is surprisingly small.

"We’re looking at around 350 autopsies a year, and in around fifty per cent of them we find one or more type of QT-prolonging medication, so it would be fairly easy to suspect that many deaths are due to these medications," she says and continues:

"But we must recognise that there are many competing causes, and we very rarely actually suspect that treatment with these medications can kill otherwise physically healthy people."

However, according to Charlotte Uggerhøj, the study should not lead to changes in practice, and QT-prolonging medication should still be used with respect and not be prescribed unless absolutely necessary.

"There is a lot of talk about these medications, but until now we haven't known how often a person dies due to them. Now our study provides a little insight. But even though we only find a very small number of people, these are still young people. We also know that the risk of these medications triggering heart rhythm irregularities is greater, for example in the case of heart disease, so we can’t rule out that they may have contributed to deaths in some other cases."  

The study in brief:

Cross-sectional study.

Who is behind the study: Hafsa Ahmed, MD; Maiken Kudahl Larsen, Medical Specialist in Forensic Medicine & PhD; Morten Rix Hansen, Medical Specialist in Clinical Pharmacology & PhD; Charlotte Uggerhøj Andersen, Medical Specialist in Clinical Pharmacology & PhD.

Who financed the study? Funding was not provided for this study.

Any potential conflicts of interest: None

Where and when was the study published? 27 June 2021 in Forensic Science International.

Contact

Charlotte Uggerhøj, clinical Associate professor, PhD at the Department of Forensic Medicine, Aarhus University.

Mail: cua@forens.au.dk

Phone: +4560128430