International Journal of Risk & Safety in Medicine 26 (2014) 71–79 DOI 10.3233/JRS-140615 IOS Press 71 Patient Safety Sudden cardiac death & The Reverse Dodo Verdict David Healy a,* , Gareth Howe a , Derelie Mangin b and Joanna Le Noury a a North Wales Department of Psychological Medicine, Bangor, Wales, UK b David Braley & Nancy Gordon Chair of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, Canada Received 7 January 2014 Accepted 24 April 2014 Abstract. Adverse effects of treatment on cardiac QT intervals were first reported 50 years ago. A clear link to sudden death was established, but the problem remained relatively unknown. The issue of treatment related effects on the heart, and the contribution this might make to sudden cardiac deaths in general, came more clearly into focus 20 years ago, linked to regulatory actions. In an era of polypharmacy, and mixing of prescribed and non-prescribed pharmacologically active agents it is now becoming increasingly clear that unanticipated cardiac effects may be common and a significant cause of mortality. There is likely underreporting and also underdiagnosis, as recognition requires a timely ECG. This paper proposes two methods to handle the problem. Keywords: QT intervals, antipsychotics, antidepressants, polypharmacy, reverse dodo verdict, adverse event databases, cardiac apps 1. The problem In 2000, a 15 year old girl, prescribed cisapride for a mild eating disorder, collapsed without warning and died in front of her family [1]. A bill introduced to the Canadian Parliament by the father of the girl, Terence Young, looks set to lead to mandatory adverse event reporting in Canada. Cisapride lengthens QT intervals, as do conditions such as eating disorders that produce metabolic disturbances. Prolonged QT intervals are a risk factor for arrhythmias of which the best known ‘Torsades de Pointes’ causes sudden and unexpected cardiac death. Groups who are higher risk of prolonged QT interval are women, and those with electrolyte disturbances often produced by medications. Other chronic conditions such as thyroid problems, diabetes, renal and liver problems increase risk. Older patients are at greater risk than younger ones. In addition, older patients take an average of 7 drugs, and the existence of multimorbidity is common [2]. * Address for correspondence: David Healy, North Wales Department of Psychological Medicine, Bangor, Wales LL57 2PW, U.K. E-mail: David.Healy54@googlemail.com. 0924-6479/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved