Major adverse cardiac events with haloperidol: A meta-analysis
Bibliographic record
Abstract
BACKGROUND: Haloperidol is a commonly used antipsychotic drug and a frequent source of medication safety alerts because of its listing as a "known risk" QT interval-prolonging medication (QTPmed). We aimed to summarize the high-quality literature on the frequency and nature of proarrhythmic major adverse cardiac events (MACE) associated with haloperidol. METHODS: We searched Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Central for randomized controlled trials (RCTs) involving patients 18 years or older comparing haloperidol to placebo. The FDA-adapted MACE composite included death, non-fatal cardiac arrest, ventricular tachyarrhythmia including torsades de pointes, and seizure or syncope. Random-effects meta-analyses were performed with a treatment-arm continuity correction for single and double zero event studies. RESULTS: 84 RCTs (n = 12180, 46% female), 23.8% of trials reported mean or median ages of their participants to be older than 65 years with 37 (44.0%) involving participants with psychiatric diagnoses, and 50 (59.5%) including electrocardiograms. Median follow-up duration was 28.0 days (interquartile range [IQR]=51.0). There were 1144 events, of which 97.8% were deaths, with 22 ventricular arrhythmias and 3 seizures or syncope. There was no difference in MACE with exposure to haloperidol compared to placebo (risk ratio [RR] 0.93, 95% CI: 0.80-1.08; I2 = 0%). IV haloperidol was not associated with increased risk of mortality (n = 5873, RR: 0.88, 95%CI:0.72-1.08). CONCLUSIONS: We did not find that haloperidol was arrhythmogenic or increased mortality in these largely short-duration trials. Further research to clarify actual clinical outcomes related to QTPmeds is important to inform safe prescribing practices.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.022 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.067 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".