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10.3390/life15101545
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Electrocardiographic Abnormalities in Elderly Patients Receiving Psychotropic Therapy in the Emergency Department: A Retrospective Cohort Study

by
Marianna Mazza
1,2,*,†,
Marcello Covino
3,†,
Filippo Bambini
3,
Enrico Romagnoli
4,
Giuseppe Biondi-Zoccai
5,6,
Mariella Fuorlo
3,
Fabiana Barone
3,
Simona Racco
3,
Benedetta Simeoni
3,
Francesco Franceschi
3,
Gabriele Sani
1,2,‡ and
Giuseppe Marano
1,2,*,‡
1
Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
2
Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
3
Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
4
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
5
Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
6
GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
These authors contributed equally to this work.
Life 2025, 15(10), 1545; https://doi.org/10.3390/life15101545
Submission received: 7 September 2025 / Revised: 27 September 2025 / Accepted: 30 September 2025 / Published: 1 October 2025
(This article belongs to the Section Medical Research)
Versions Notes

Abstract

Background: Psychotropic medications are frequently prescribed to elderly patients in emergency settings, yet their potential to induce electrocardiographic (ECG) abnormalities, particularly QTc interval prolongation, raises safety concerns. Older adults may be especially vulnerable due to polypharmacy, age-related cardiac changes, and comorbidities. Methods: We conducted a retrospective observational study on patients aged ≥65 years who underwent psychiatric evaluation in the Emergency Department (ED) of a tertiary hospital between 2015 and 2023. Data was extracted on demographics, psychiatric symptoms, psychotropic drug use, and ECG findings. The primary outcome was the prevalence of major ECG abnormalities (QTc or QRS prolongation), and secondary analyses explored associations with drug class and hospitalization. Results: Seventy-seven patients were included (62.3% female, median age 74 years). Overall, 22.1% exhibited ECG abnormalities, with QTc prolongation in 16.9% and QRS widening in 5.2%. ECG alterations were more common among patients receiving psychotropic drugs (30.7% vs. 13.2%; p = 0.046). Multivariate analysis confirmed psychotropic therapy as an independent predictor of ECG abnormalities (OR 2.84; 95% CI: 1.01–7.98; p = 0.049). No significant sex-related differences were observed. Conclusions: ECG abnormalities are common in elderly patients undergoing psychiatric assessment in the ED and seem associated with psychotropic medication use. However, non-pharmacological factors also contribute significantly to risk. Integrated multidisciplinary evaluation is essential to ensure both psychiatric and cardiovascular safety in this fragile population.
Keywords: QTc prolongation; electrocardiography; psychotropic drugs; elderly; emergency department; cardiac safety; polypharmacy; antipsychotics; antidepressants; geriatric psychiatry QTc prolongation; electrocardiography; psychotropic drugs; elderly; emergency department; cardiac safety; polypharmacy; antipsychotics; antidepressants; geriatric psychiatry

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MDPI and ACS Style

Mazza, M.; Covino, M.; Bambini, F.; Romagnoli, E.; Biondi-Zoccai, G.; Fuorlo, M.; Barone, F.; Racco, S.; Simeoni, B.; Franceschi, F.; et al. Electrocardiographic Abnormalities in Elderly Patients Receiving Psychotropic Therapy in the Emergency Department: A Retrospective Cohort Study. Life 2025, 15, 1545. https://doi.org/10.3390/life15101545

AMA Style

Mazza M, Covino M, Bambini F, Romagnoli E, Biondi-Zoccai G, Fuorlo M, Barone F, Racco S, Simeoni B, Franceschi F, et al. Electrocardiographic Abnormalities in Elderly Patients Receiving Psychotropic Therapy in the Emergency Department: A Retrospective Cohort Study. Life. 2025; 15(10):1545. https://doi.org/10.3390/life15101545

Chicago/Turabian Style

Mazza, Marianna, Marcello Covino, Filippo Bambini, Enrico Romagnoli, Giuseppe Biondi-Zoccai, Mariella Fuorlo, Fabiana Barone, Simona Racco, Benedetta Simeoni, Francesco Franceschi, and et al. 2025. "Electrocardiographic Abnormalities in Elderly Patients Receiving Psychotropic Therapy in the Emergency Department: A Retrospective Cohort Study" Life 15, no. 10: 1545. https://doi.org/10.3390/life15101545

APA Style

Mazza, M., Covino, M., Bambini, F., Romagnoli, E., Biondi-Zoccai, G., Fuorlo, M., Barone, F., Racco, S., Simeoni, B., Franceschi, F., Sani, G., & Marano, G. (2025). Electrocardiographic Abnormalities in Elderly Patients Receiving Psychotropic Therapy in the Emergency Department: A Retrospective Cohort Study. Life, 15(10), 1545. https://doi.org/10.3390/life15101545

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