{
  "abstract": "Objectives To map the risk profile of drug classes at the population level by identifying associations between newly prescribed reimbursed drugs and sudden cardiac arrest (SCA), thereby providing a systematic basis for assessing individual drug effects.Design Population-based, matched case-control study.Setting Greater Vienna area, Austria, using linked data from the Austrian Healthcare Reimbursement Database and the Vienna Ambulance Service between 2013 and 2020.Participants A total of 31 330 insured individuals were included from an estimated 14 448 612 person-years at risk. Cases (n=6266) were patients with SCA, each matched 1:4 to controls (n=25 064) without SCA by age, sex and event date. The estimated absolute case risk equals 43.4 per 100 000 person-years.Interventions Newly prescribed reimbursed drugs within 4 weeks before the SCA event, classified according to four-digit Anatomical Therapeutic Chemical (ATC) codes.Main analyses Associations between newly prescribed drug classes and SCA, estimated using conditional logistic regression and expressed as ORs with 95% CIs, adjusted for comorbidities and concomitant medications prescribed 120–29 days before the event.Results Among 322 relevant ATC drug classes, 245 were newly prescribed within 28 days prior to the SCA event. Of these, 57 (23%) were significantly associated with SCA. Eight drug classes demonstrated a markedly elevated risk (OR≥10), including oripavine derivatives (OR 64, 95% CI 8 to 486), other cardiac preparations (OR 22, 95% CI 2 to 204), plain antiandrogens (OR 18, 95% CI 1.2 to 275) and phenylpiperidine derivatives (OR 16, 95% CI 7 to 38). The most frequently prescribed associated drug classes were penicillins with beta-lactamase inhibitors (179 cases; OR 2.17, 95% CI 1.8 to 2.7), pyrazolones (167 cases; OR 2.14, 95% CI 1.7 to 2.7) and adrenergics combined with anticholinergics (130 cases; OR 2.94, 95% CI 2.2 to 3.9).Conclusions Numerous outpatient-prescribed drug classes were associated with SCA. This exploratory, population-based analysis provides a systematic map of potential safety signals to inform more detailed pharmaco-epidemiological investigations, in which confounding and causality can be examined more rigorously.",
  "authors": [
    {
      "affiliations": [
        "Universitätsklinik für Klinische Pharmakologie, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Safoura Sheikh Rezaei"
    },
    {
      "affiliations": [
        "Center for Medical Data Science, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Martina Mittlböck"
    },
    {
      "affiliations": [
        "Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Michael Schwameis"
    },
    {
      "affiliations": [
        "Dachverband der Sozialversicherungsträger, Wien, Austria"
      ],
      "name": "Thomas Bergmair"
    },
    {
      "affiliations": [
        "Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Michael Holzer"
    },
    {
      "affiliations": [
        "Emergency Medical Service Vienna, Wien, Austria",
        "PULS Austrian Cardiac Arrest Awareness Association, Wien, Austria"
      ],
      "name": "Mario Krammel"
    },
    {
      "affiliations": [
        "Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Gynäkologische Endokrinologie und Reproduktionsmedizin, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Magdalena Sophie Boegl"
    },
    {
      "affiliations": [
        "Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Anne Elisabeth Merrelaar"
    },
    {
      "affiliations": [
        "Universitätsklinik für Innere Medizin I, Intensivstation13i2, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Nina Buchtele"
    },
    {
      "affiliations": [
        "Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Alexandra Julia Lipa"
    },
    {
      "affiliations": [
        "Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Daniel Kogler"
    },
    {
      "affiliations": [
        "Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Austria"
      ],
      "name": "Harald Herkner"
    }
  ],
  "title": "Mapping drug-class associations with sudden cardiac arrest in the outpatient setting: an exploratory population-based case-control analysis",
  "uid": "c0e7aff9-19ba-5bb4-8169-f10aa33bf166"
}