Schizophrenia linked to higher heart rate and QT dispersion in meta-analysis

A systematic review and meta-analysis of observational studies published between 2015 and 2025 synthesized data from 5,648 adults with schizophrenia and 23,636 healthy controls to evaluate cardiac electrophysiological differences. The primary focus was on heart rate and various QT/QTc indices, with secondary outcomes including frontal QRS-T angle, Tp-e interval, and dispersion measures. The analysis revealed that patients with schizophrenia had a significantly higher heart rate compared to controls, with a mean difference of 6.24 bpm (95% CI 2.01-10.46). QT dispersion was also markedly increased, with a mean difference of 13.00 ms (95% CI 3.58-22.42), and QTc dispersion was even more elevated at 21.23 ms (95% CI 18.23-24.23).

Further findings indicated a modest prolongation of QTc in schizophrenia patients, though the QT interval itself showed no significant difference between groups. The frontal QRS-T angle was increased by 26.11 degrees (95% CI 19.10-33.11), and the Tp-e interval was prolonged by 3.92 ms (95% CI 2.35-5.49). Tp-e dispersion was greater by 8.21 ms (95% CI 6.56-9.85), while the Tp-e/QT ratio did not differ significantly. These results collectively point to altered cardiac repolarization in schizophrenia, which may contribute to arrhythmia risk.

From a clinical perspective, these electrophysiological changes underscore the importance of cardiac monitoring in schizophrenia management. Although the study did not report primary outcomes or safety data, the consistent findings across multiple indices suggest a need for heightened vigilance for cardiac events in this population. The meta-analysis design strengthens the evidence, but the observational nature of included studies limits causal inference.

Limitations of the review include the lack of reported primary outcomes, follow-up data, and safety information. Funding and conflicts of interest were not disclosed, and the certainty of evidence was not formally assessed. Despite these gaps, the large sample size and comprehensive outcome assessment provide valuable insights for healthcare providers.

In practice, clinicians should consider baseline cardiac assessments for patients with schizophrenia, especially when initiating or adjusting antipsychotic medications that may affect QT intervals. While this meta-analysis does not establish causality, it highlights a plausible association between schizophrenia and cardiac electrophysiological abnormalities, warranting further prospective studies.