Transcript Risk of Serious Cardiac Events in Older Adults Using Antipsychotic

Risk of Serious Cardiac Events in Older
Adults Using Antipsychotic Agents
Sandhya Mehta, MS; Hua Chen, MD, PhD; Michael Johnson, PhD; and
Rajender R. Aparasu, MPharm, PhD
Am J Geriatr Pharmacother. 2011; 9: 120-132
Alicia Williams
2012 PharmD Candidate
Mercer University COPHS
July 7, 2011
Typical Antipsychotics
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loxapine
fluphenazine
triflupromazine
chlorprothixene
haloperidol
chlorpromazine
thioridazine
prochlorperazine
promazine
trifluperazine
thiothexene
molindone
perphenazine
acetophenazine
mesoridazine
paliperidone
pimozide
perphenazine-amitriptyline
Atypical Antipsychotics
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clozapine
olanzapine
risperidone
quetiapine
ziprasidone
aripiprazole
Background
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Antipsychotic agents can cause cardiovascular events
through multiple mechanisms:
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prolongation of the QT interval
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causes orthostasis and tachyarrhythmias
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Torsade de pointes
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raised lupus anticoagulant and anticardiolipin antibody levels
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can lead to increased risk of venous thromboembolism
increased occurrence of metabolic syndrome such as type 2
diabetes, weight gain, and hypertriglyceridemia
Background
Background
Background
Background
Objective
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To compare the risk of serious cardiac
events in older adults taking typical
antipsychotics with those taking atypical
antipsychotics
Study Design
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A propensity-matched retrospective cohort
study was conducted.
The base population included all older adults
aged ≥50 years old who were on
antipsychotics from July 1, 2000 to December
31, 2007.
No funding was received for this study.
Inclusion/Exclusion Criteria
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Participants must have been continuously
eligible 6 months before and 6 months
after the index date
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Index date:
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Antipsychotic initiation
The first prescription fill date of antipsychotic
medication after at least 6 months without a
prescription fill date for these medications
The minimum follow-up period was 6 months
after the index date.
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maximum: 1 year
Patient Demographics
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A total of 5580
patients were
selected in each
antipsychotic users
group after
propensity score
matching.
Intervention
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Prescription and medication information were derived
from the IMS LifeLink Health Plan Claims database.
The two groups were matched on a propensity score
to minimize the baseline differences between the
groups.
Survival analysis was conducted on the matched
cohort to assess the risk of serious cardiovascular
events between the two groups.
Primary Endpoint
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Hospitalizations or emergency room
visit due to serious cardiac events,
including:
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thromboembolism,
myocardial infarction,
cardiac arrest,
ventricular arrhythmias,
within one year after the index date
Results
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Serious cardiac events were found in:
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666 (11.9%) of atypical antipsychotic users
698 (12.4%) of typical antipsychotic users
Survival analysis revealed that typical
antipsychotic users were at increased
risk of serious cardiovascular events
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hazard ratio = 1.21; 95% CI, 1.04-1.40
Conclusion
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Moderate increases in risk of serious cardiac
events are associated with older adults using
typical antipsychotic agents compared with
atypical users.
There is a strong need to assess the benefitto-risk ratio of antipsychotics before
prescribing them to a vulnerable population
such as the elderly.
Comment
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The use of computer-recorded information to
capture data did not allow them to ascertain
whether the participants actually used their
dispensed medications.
The population referred to in the study
comprised of community-dwelling older
adults, and the results may not be
generalizable to other settings.
Level of Evidence
Questions