{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T17:15:05Z","timestamp":1778606105961,"version":"3.51.4"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Clozapine has demonstrated superiority in improving both positive and negative symptoms of treatment\u2010resistant schizophrenia; however, there are associated treatment\u2010limiting side effects, including myocarditis, cardiomyopathy and agranulocytosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This retrospective cohort study describes the prevalence of myocarditis, left ventricular (LV) dysfunction, cardiovascular risk factors and outcomes in a cohort of patients maintained on clozapine therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were retrospectively collated from patients who had a diagnosis of schizophrenia, had been managed with clozapine at any stage during their care and undergone at least one echocardiogram.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between March 2020 and September 2021 674 patients were identified, 71% were male, with a mean age of 47\u2009years old (interquartile range (IQR) 40\u201357). The mean duration of clozapine use was 7\u2009years (IQR 4\u201313). The overall mortality was 5.54% during the follow\u2010up period. Myocarditis was identified in one patient (0.15%) within the first 30\u2009days, and an additional five cases were identified over the follow\u2010up period (0.89%). The combined incidence of heart failure (HF) and myocarditis was 1.6% during the follow\u2010up period. There was no association between LV size and function at baseline or during follow\u2010up and adverse cardiac outcomes (comprising death, myocarditis, HF). Older age at initiation of therapy and baseline E\/<jats:italic>e'<\/jats:italic> ratio were associated with risk of HF and myocarditis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The overall incidence of myocarditis and HF during follow\u2010up was low, with surveillance echocardiography offering limited predictive value. Patients maintained on clozapine are at risk of significant cardiovascular sequelae, likely reflecting an adverse risk factor profile.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.16617","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T12:24:10Z","timestamp":1736339050000},"page":"474-482","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A retrospective analysis of cardiovascular outcomes of clozapine treated individuals within Hunter New England"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3492-3781","authenticated-orcid":false,"given":"Shanathan","family":"Sritharan","sequence":"first","affiliation":[{"name":"Cardiology Department John Hunter Hospital Newcastle  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kindelan","family":"Murray","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic","family":"Lam","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Wittaker","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Sverdlov","sequence":"additional","affiliation":[{"name":"Cardiology Department John Hunter Hospital Newcastle  Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"},{"name":"Hunter Medical Research Institute  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Boyle","sequence":"additional","affiliation":[{"name":"Cardiology Department John Hunter Hospital Newcastle  Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"},{"name":"Hunter Medical Research Institute  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Davies","sequence":"additional","affiliation":[{"name":"Cardiology Department John Hunter Hospital Newcastle  Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trent","family":"Williams","sequence":"additional","affiliation":[{"name":"Cardiology Department John Hunter Hospital Newcastle  Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"},{"name":"Hunter Medical Research Institute  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Collins","sequence":"additional","affiliation":[{"name":"Cardiology Department John Hunter Hospital Newcastle  Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00442554"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-3223(01)01271-9"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.focus.18402"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2015.15030332"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2018.4489"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/YIC.0b013e32836508e6"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.12.102"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000319022"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.10.038"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.03.003"},{"key":"e_1_2_6_12_1","unstructured":"Australian Institute of Health and Welfare.Deaths in Australia. Revised 11th of July 2023. Australian Government [cited 2024 Mar 25]. Available from URL:https:\/\/www.aihw.gov.au\/reports\/life-expectancy-deaths\/deaths-in-australia\/contents\/summary"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.06.017"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.03.013"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.730769"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000001483"},{"issue":"23","key":"e_1_2_6_17_1","first-page":"39","article-title":"Clozapine: diabetes mellitus, weight gain, and lipid abnormalities","volume":"62","author":"Henderson DC","year":"2001","journal-title":"J Clin Psychiatry"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.157.6.975"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2010.03783.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2020.01.015"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.2952"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1607141"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2307563"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.16617","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T02:57:36Z","timestamp":1743562656000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.16617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,8]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1111\/imj.16617"],"URL":"https:\/\/doi.org\/10.1111\/imj.16617","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,8]]},"assertion":[{"value":"2024-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}