Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization.
Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization.
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DOI：
10.1001/jamanetworkopen.2023.0063
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发表时间：
2023-02-01
影响因子：
13.8
通讯作者：
Lin, Kueiyu Joshua
中科院分区：
文献类型：
--
作者：
Zhang, Yichi;Wilkins, James M.;Bessette, Lily Gui;York, Cassandra;Wong, Vincent;Lin, Kueiyu Joshua
老年人感染相关住院后停用抗精神病药物（APM）的比率和相关患者特征是什么？在这项美国5835例患者的队列研究中，我们观察到在感染相关住院后开始治疗后30天，新的非典型APM使用者的停药率仅为11%，新的氟哌啶醇使用者的停药率为52%。痴呆和住院时间延长与氟哌啶醇和非典型APM停药呈负相关。这些结果表明，与临床建议相反，感染相关住院后APM停药率较低，非典型APM的停药率低于氟哌啶醇。这项队列研究评估了美国老年人抗精神病药物的使用情况，包括感染相关住院后停药的发生率和患者特征。在老年人的常规护理中，用于治疗由于急性住院而引起的谵妄的抗精神病药物（APM）的停药率数据有限。研究美国老年人感染相关住院后用于治疗谵妄的APM的停药率和患者特征。这项回顾性队列研究使用2004年1月1日至2022年5月31日的美国索赔数据（Optum的去识别Clinformatics Data Mart数据库）进行。患者年龄≥ 65岁，既往无精神疾病，在感染相关住院后30天内新开始使用APM处方。于2022年12月15日进行统计分析。口服氟哌啶醇和非典型APM（阿立哌唑、奥氮平、奎替鲁、利培酮等）的新使用（入组前任何时间均无既往使用）。主要结局是APM停药，定义为APM分发结束后间隔超过15天。使用生存分析和Kaplan-Meier分析。我们的研究人群包括5835例患者。在这些个体中，790例（13.5%）为新的氟哌啶醇使用者（平均[SD]年龄，81.5 [6.7]岁; 422例女性[53.4%]），5045例（86.5%）为新的非典型APM使用者（平均[SD]年龄，79.8 [7.0]岁; 2636例女性[52.2%]）。在非典型APM使用者中，开始治疗后30天停药的累积发生率为11.4%（95% CI，10.4%-12.3%），在氟哌啶醇使用者中为52.1%（95% CI，48.2%-55.7%）（氟哌啶醇与非典型APM之间的差异P <0.001）。我们观察到从2004年到2022年，氟哌啶醇使用者的停药率呈上升趋势（每年增加5%[95%CI，3%-7%]）（调整后的风险比，1.05 [1.03-1.07]; P <0.001），但非典型APM使用者的停药率没有上升趋势（1.00 [0.99-1.01]; P = 0.67）。住院时间延长和痴呆与停用氟哌啶醇和非典型APM呈负相关。这项队列研究的结果表明，非典型APM使用者在感染相关住院后因谵妄而停用新启动APM的比例低于氟哌啶醇使用者，住院时间延长和痴呆是主要相关变量。近年来，氟哌啶醇的停药率明显较高，但非典型APM的停药率并不高。
What are the rates and associated patient characteristics of discontinuation of antipsychotic medications (APMs) among older adults following infection-related hospitalization? In this cohort study of 5835 patients in the US, we observed discontinuation rates of only 11% for new atypical APM users and 52% for new haloperidol users by 30 days after initiation following infection-related hospitalization. Dementia and prolonged hospitalization were inversely associated with haloperidol and atypical APM discontinuation. These findings suggest that contrary to clinical recommendations, APM discontinuation rates following infection-related hospitalization are low and are lower for atypical APMs than for haloperidol. This cohort study assesses antipsychotic medication use among older US adults, including rates of and patient characteristics associated with discontinuation, following infection-related hospitalization. There are limited data on discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization in the routine care of older adults. To investigate discontinuation rates and patient characteristics of APMs used to treat delirium following infection-related hospitalization among older US adults. This retrospective cohort study was conducted using US claims data (Optum’s deidentified Clinformatics Data Mart database) for January 1, 2004, to May 31, 2022. Patients were aged 65 years or older without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. Statistical analysis was performed on December 15, 2022. New use (no prior use any time before cohort entry) of oral haloperidol and atypical APMs (aripiprazole, olanzapine, quetiapine, risperidone, etc). The primary outcome was APM discontinuation, defined as a gap of more than 15 days following the end of an APM dispensing. Survival analyses and Kaplan-Meier analyses were used. Our study population included 5835 patients. Of these individuals, 790 (13.5%) were new haloperidol users (mean [SD] age, 81.5 [6.7] years; 422 women [53.4%]) and 5045 (86.5%) were new atypical APM users (mean [SD] age, 79.8 [7.0] years; 2636 women [52.2%]). The cumulative incidence of discontinuation by 30 days after initiation was 11.4% (95% CI, 10.4%-12.3%) among atypical APM users and 52.1% (95% CI, 48.2%-55.7%) among haloperidol users (P < .001 for difference between haloperidol vs atypical APMs). We observed an increasing trend in discontinuation rates from 2004 to 2022 (5% increase [95% CI, 3%-7%] per year) for haloperidol users (adjusted hazard ratio, 1.05 [1.03-1.07]; P < .001) but not for atypical APM users (1.00 [0.99-1.01]; P = .67). Prolonged hospitalization and dementia were inversely associated with the discontinuation of haloperidol and atypical APMs. The findings of this cohort study suggest that the discontinuation rate of newly initiated APMs for delirium following infection-related hospitalization was lower in atypical APM users than in haloperidol users, with prolonged hospitalization and dementia as major associated variables. The discontinuation rate was substantially higher in recent years for haloperidol but not for atypical APMs.
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DOI：
10.1093/gerona/glz224
发表时间：
2020-06-01
影响因子：
5.1
作者：
Kim, Dae Hyun;Patorno, Elisabetta;Glynn, Robert J.
通讯作者：
Glynn, Robert J.
影响因子：
39.2
作者：
Gill, Sudeep S.;Bronskill, Susan E.;Rochon, Paula A.
通讯作者：
Rochon, Paula A.
影响因子：
6.3
作者：
Herzig, Shoshana J.;Rothberg, Michael B.;Marcantonio, Edward R.
通讯作者：
Marcantonio, Edward R.
DOI：
10.1093/gerona/glx229
发表时间：
2018-07-01
影响因子：
5.1
作者：
Kim, Dae Hyun;Schneeweiss, Sebastian;Avorn, Jerry
通讯作者：
Avorn, Jerry
影响因子：
6.3
作者：
Kim DH;Huybrechts KF;Patorno E;Marcantonio ER;Park Y;Levin R;Abdurrob A;Bateman BT
通讯作者：
Bateman BT