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Risk of Cardiac Morbidities and Sudden Death in Patients With Epilepsy and No History of Cardiac Disease: A Population-Based Nationwide Study

Published:January 28, 2021DOI:



      To investigate the impact of epilepsy on secondary cardiac morbidities and sudden death in patients with epilepsy.

      Patients and Methods

      The present cohort study evaluated data obtained from a subset of adult patients listed in the Taiwan National Health Insurance Research Database with an International Classification of Diseases, Ninth Revision, diagnosis code of epilepsy from January 1, 1997, to December 31, 2013; the date of epilepsy diagnosis or antiepilepsy drug prescription was defined as the index date. Patients with cardiac disease prior to the index date were excluded, and the remaining patients were categorized into epilepsy and nonepilepsy groups. Frequency matching was performed to balance the covariates across groups for the comparison of outcomes. The development of myocardial infarction (MI) and arrhythmia and/or the occurrence of sudden death were the outcomes for evaluation. A Cox proportional hazards regression model and competing risk analysis were used to compare the risks of cardiac morbidities and sudden death between groups.


      The final analysis included a total of 5411 patients with epilepsy and 21,644 participants without epilepsy. The epilepsy group had significantly higher risks for development of MI (hazard ratio [HR], 1.71; 95% CI, 1.62 to 1.81; P<.001) and arrhythmia (HR, 2.11; 95% CI, 1.97 to 2.25; P<.001) and the occurrence of sudden death (HR, 1.83; 95% CI, 1.53 to 2.18; P<.001) compared with the nonepilepsy group.


      Our results indicate that the risks for development of MI and arrhythmia and the occurrence of sudden death were higher in patients with epilepsy. These findings support the hypothesis that epilepsy may lead to secondary cardiac dysfunction and increases the risk of sudden death.

      Abbreviations and Acronyms:

      AED (antiepileptic drug), CI (confidence interval), CKD (chronic kidney disease), COPD (chronic obstructive pulmonary disease), CVA (cerebrovascular accident), DM (diabetes mellitus), HR (hazard ratio), HTN (hypertension), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), MI (myocardial infarction), NHIRD (National Health Insurance Research Database), SUDEP (sudden unexpected death in epilepsy)
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