Riassunto.
STATO DELL'ARTE. Nonostante la limitata evidenza di efficacia, gli
antipsicotici (AP) sono comunemente usati per trattare il delirio. C'è
stata poca ricerca sui risultati a lungo termine dei pazienti che sono
stati avviati dagli ospedali all'uso di antipsicotici (APs).
METODI. Usando una coorte retrospettiva di 300 anziani (≥65 anni) a
cui erano stati prescritti per la prima volta antipsicotici mentre erano
ospedalizzati tra il 1 ° ottobre 2012 e il 31 settembre 2013,
precedentemente descritta, abbiamo esaminato a 1 anno dalla dimissione i
pazienti vivi. Abbiamo esaminato il numero di riammissioni, i motivi di
riammissione, la durata della terapia antipsicotica, l'uso di altri
farmaci sedativi e l'incidenza della riammissione. Abbiamo usato
L'indice Nazionale di Mortalità ["National Death Index", N.d.T.] per
descrivere la mortalità ad 1 anno dalla dimissionee poi abbiamo creato
un modello multivariabile per identificare i predittori della mortalità
ad 1 anno.
RISULTATI. I 260 pazienti dimessi vivi, dal loro indice di
ammissione, avevano un tasso di mortalità ad 1 anno del 29% (75/260).
Dei 146/260 pazienti dimessi in trattamento con antipsicotici 60 (41%)
pazienti hanno avuto almeno 1 riammissione. Al momento della prima
riammissione, il 65% dei pazienti stava ancora assumendo gli stessi
antipsicotici con cui erano stati dimessi. Diciotto pazienti hanno
ricevuto nuovi antipsicotici durante i ricoveri successivi al primo. I
predittori di morte a 1 anno sono risultati la dimissione da centri per
il trattamento post-acuto (odds ratio [OR]: 2,28, intervallo di
confidenza al 95% [CI]: 1,10-4,73, P = 0,03) e il prolungamento
dell'intervallo QT> 500 ms nel corso del ricovero ( OR: 3,41; IC 95%:
1,34-8,67, P = 0,01).
CONCLUSIONI. L'inizio di un trattsmento con antipsicotici in ospedale
è probabile che porti a un uso a lungo termine di questi farmaci. I
pazienti che hanno ricevuto un trattamento con antipsicotici durante un
ricovero erano ad alto rischio di morte l'anno successivo.
-
Loh
KP (1), Ramdass S (2), Garb JL (3), Thim M (2), Brennan MJ (4,5),
Lindenauer PK (2,4,6), Lagu T (2,4,6). Esiti a lungo termine degli
anziani dimessi in trattamento con antipsicotici. Giornale di Medicina
Ospedaliera, 2016 agosto; 11 (8): 550-5. doi: 10.1002 / jhm.2585. Epub
2016 6 aprile. Informazioni sugli autori: (1) Divisione di
Ematologia/Oncologia, Istituto di Oncologia James P. Wilmot, Università
di Rochester / Strong Memorial Hospital, Rochester, New York; (2)
Dipartimento di Medicina, Centro Medico Baystate, Springfield,
Massachusetts; (3) Divisione degli Affari Accademici, Centro Medico
Baystate/Scuola Universitaria di Medicina Tufts, Springfield,
Massachusetts; (4) Dipartimento di Medicina, Scuola Universitaria di
Medicina Tufts Medicine, Springfield, Massachusetts; (5) Divisione di
Geriatria, Cure Palliative e Medicina Post-Acuta, Centro Medico
Baystate, Springfield, Massachusetts; (6) Centro per la Ricerca sulla
Qualità dell'Assistenza, Centro Medico Baystate, Springfield,
Massachusetts.
---
Abstract
BACKGROUND:
Despite limited evidence of efficacy, antipsychotics (APs) are commonly used to treat delirium. There has been little research on the long-term outcomes of patients who are started on APs in the hospital.
Despite limited evidence of efficacy, antipsychotics (APs) are commonly used to treat delirium. There has been little research on the long-term outcomes of patients who are started on APs in the hospital.
METHODS:
Using a previously described retrospective cohort of 300 elders (≥65 years old) who were newly prescribed APs while hospitalized between October 1, 2012 and September 31, 2013, we examined the 1-year outcomes of patients alive at the time of discharge. We examined number of readmissions, reasons for readmission, duration of AP therapy, use of other sedating medications, and incidence of readmission. We used the National Death Index to describe 1-year mortality and then created a multivariable model to identify predictors of 1-year mortality.
Using a previously described retrospective cohort of 300 elders (≥65 years old) who were newly prescribed APs while hospitalized between October 1, 2012 and September 31, 2013, we examined the 1-year outcomes of patients alive at the time of discharge. We examined number of readmissions, reasons for readmission, duration of AP therapy, use of other sedating medications, and incidence of readmission. We used the National Death Index to describe 1-year mortality and then created a multivariable model to identify predictors of 1-year mortality.
RESULTS:
The 260 patients discharged alive from their index admissions had a 1-year mortality rate of 29% (75/260). Of the 146/260 patients discharged on APs, 60 (41%) patients experienced at least 1 readmission. At the time of first readmission, 65% of patients were still taking the same APs on which they had been discharged. Eighteen patients received new APs during the readmission hospitalizations. Predictors of death at 1 year included discharge to postacute facilities after index admission (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.10-4.73, P = 0.03) and QT interval prolongation >500 ms during index admission (OR: 3.41; 95% CI: 1.34-8.67, P = 0.01).
The 260 patients discharged alive from their index admissions had a 1-year mortality rate of 29% (75/260). Of the 146/260 patients discharged on APs, 60 (41%) patients experienced at least 1 readmission. At the time of first readmission, 65% of patients were still taking the same APs on which they had been discharged. Eighteen patients received new APs during the readmission hospitalizations. Predictors of death at 1 year included discharge to postacute facilities after index admission (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.10-4.73, P = 0.03) and QT interval prolongation >500 ms during index admission (OR: 3.41; 95% CI: 1.34-8.67, P = 0.01).
CONCLUSIONS:
Initiating an AP in the hospital is likely to result in long-term use of these medications. Patients who received an AP during a hospitalization were at high risk of death in the following year. Journal of Hospital Medicine 2016;11:550-555. © 2016 Society of Hospital Medicine.
Initiating an AP in the hospital is likely to result in long-term use of these medications. Patients who received an AP during a hospitalization were at high risk of death in the following year. Journal of Hospital Medicine 2016;11:550-555. © 2016 Society of Hospital Medicine.
Loh KP (1), Ramdass S (2), Garb JL (3), Thim M (2), Brennan MJ (4,5),
Lindenauer PK (2,4,6), Lagu T (2,4,6), Long-term outcomes of elders
discharged on antipsychotics. Hosp Med. 2016 Aug;11(8):550-5. doi:
10.1002/jhm.2585. Epub 2016 Apr 6. Author information: (1) Division of
Hematology/Oncology, James P. Wilmot Cancer Institute, University of
Rochester/Strong Memorial Hospital, Rochester, New York; (2) Department
of Medicine, Baystate Medical Center, Springfield, Massachusetts; (3)
Division of Academic Affairs, Baystate Medical Center/Tufts University
School of Medicine, Springfield, Massachusetts; (4) Department of
Medicine, Tufts University School of Medicine, Springfield,
Massachusetts; (5) Division of Geriatrics, Palliative Care and
Post-Acute Medicine, Baystate Medical Center, Springfield,
Massachusetts; (6) Center for Quality of Care Research, Baystate Medical
Center, Springfield, Massachusetts.
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