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

## TL;DR

This study finds that elderly patients receiving psychotropic drugs in emergency settings are more likely to have abnormal heart rhythms, highlighting the need for careful monitoring.

## Contribution

The study identifies psychotropic therapy as an independent predictor of ECG abnormalities in elderly emergency department patients.

## Key findings

- 22.1% of elderly patients had ECG abnormalities, with 16.9% showing QTc prolongation.
- Patients on psychotropic drugs had a 30.7% rate of ECG abnormalities versus 13.2% without.
- Psychotropic therapy was confirmed as an independent predictor of ECG abnormalities.

## 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.