Associations between COVID-19 and 30-day thromboembolic events and mortality in people with dementia receiving antipsychotic medications.
Associations between COVID-19 and 30-day thromboembolic events and mortality in people with dementia receiving antipsychotic medications.
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DOI：
10.1016/j.phrs.2021.105534
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发表时间：
2021-05
影响因子：
9.3
通讯作者：
Lip, Gregory Y. H.
中科院分区：
文献类型：
--
作者：
Harrison, Stephanie L.;Buckley, Benjamin J. R.;Lane, Deirdre A.;Underhill, Paula;Lip, Gregory Y. H.
抗精神病药物经常被开给痴呆症患者，以控制行为和心理症状。使用全球联合研究网络，目的是确定：1）COVID-19是否与接受抗精神病药物治疗的痴呆症患者的30天血栓栓塞事件和死亡率相关;以及2）与2019年相比，COVID-19大流行期间接受抗精神病药物治疗的痴呆症患者比例是否更高。使用TriNetX（一个全球联合健康研究网络）进行了一项回顾性队列研究。该网络检索了2020年1月20日至2020年12月5日期间电子病历中记录的年龄≥ 65岁的痴呆症、COVID-19和COVID-19前30天内使用抗精神病药物的人群。这些人与2019年的历史对照进行了比较，这些人在访问参与医疗保健组织之前的30天内患有痴呆症并使用抗精神病药物。使用年龄、性别、种族、合并症以及抗抑郁药和抗惊厥药使用的倾向评分匹配来平衡有和无COVID-19的队列。在TriNetX网络中，确定了8414名患有COVID-19、痴呆症和使用抗精神病药物的个体以及31，963名历史对照。在倾向评分匹配后，有8396名COVID-19患者和8396名历史对照。队列在年龄、性别、种族、合并症以及抗抑郁药和抗惊厥药的使用方面平衡良好。在COVID-19成人患者中，30天血栓栓塞事件和全因死亡率的几率显著更高（比值比分别为：1.36（95%置信区间（CI）：1.21-1.52）和1.93（1.71-2.17））。在2020年1月20日至2020年12月5日期间，前往参与医疗机构的痴呆症患者人数较低（n = 165，447）与2019年同期相比（n = 217，391），但接受抗精神病药物的比例从14.7%（95%CI：14.6-14.9%）增加到16.4%（95%CI：16.2-16.5%），P <0.0001。这些发现为证据基础提供了补充，即在COVID-19大流行期间，痴呆症患者接受抗精神病药物的比例有所增加。抗精神病药物对痴呆患者的负面影响可能会因伴随的COVID-19而加剧。
Antipsychotic medications are frequently prescribed to people with dementia to manage behavioural and psychological symptoms. Using a global federated research network, the objectives were to determine: 1) if COVID-19 is associated with 30-day thromboembolic events and mortality for people with dementia receiving antipsychotic medications; and 2) if the proportion of people with dementia receiving antipsychotics is higher during the COVID-19 pandemic compared to 2019. A retrospective cohort study was conducted using TriNetX, a global federated health research network. The network was searched for people aged ≥ 65 years with dementia, COVID-19 and use of antipsychotics in the 30-days prior to COVID-19 recorded in electronic medical records between 20/01/2020 and 05/12/2020. These individuals were compared to historical controls from 2019 with dementia and use of antipsychotics in the 30-days before a visit to a participating healthcare organisation. Propensity score matching for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants was used to balance cohorts with and without COVID-19. Within the TriNetX network, 8414 individuals with COVID-19, dementia and use of antipsychotics and 31,963 historical controls were identified. After propensity score matching there were 8396 individuals with COVID-19 and 8396 historical controls. The cohorts were well balanced for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants. The odds of 30-day thromboembolic events and all-cause mortality were significantly higher in adults with COVID-19 (Odds Ratios: 1.36 (95% confidence interval (CI): 1.21–1.52) and 1.93 (1.71–2.17), respectively). The number of people with dementia with a visit to a participating healthcare organisation was lower between 20/01/2020 and 05/12/2020 (n = 165,447) compared to the same period in 2019 (n = 217,391), but the proportion receiving antipsychotics increased from 14.7% (95%CI: 14.6–14.9%) to 16.4% (95%CI: 16.2–16.5%), P < .0001. These findings add to the evidence base that during the COVID-19 pandemic there was an increase in the proportion of people with dementia receiving antipsychotics. The negative effects of antipsychotics in patients with dementia may be compounded by concomitant COVID-19.
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