Prior Atypical Antipsychotic Use May Increase Mortality Risk in Pneumonia

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Atypical antipsychotics are commonly used in older patients to treat psychiatric conditions and dementia.
Atypical antipsychotics are commonly used in older patients to treat psychiatric conditions and dementia.

SAN DIEGO — Prior use of atypical antipsychotics was associated with increased odds of mortality in patients aged 65 years or older who were hospitalized for pneumonia, according to research presented at the American Thoracic Society (ATS) 2018 International Conference, held May 28 to 23, 2018, in San Diego, California.

To examine whether the use of atypical antipsychotics before hospitalization for pneumonia was associated with increased mortality in an older population, researchers conducted a retrospective cohort study of hospitalized patients with pneumonia at any Department of Veterans Affairs (VA) hospital during a period of 10 years. Researchers included patients aged 65 years and older who consistently received VA care. 

To examine the association of atypical antipsychotics and mortality, researchers used multilevel regression models after controlling for potential confounders including age, sex, sociodemographic factors, comorbid conditions, and other medications.

The cohort had a total of 103,997 patients, 5977 of whom were taking atypical antipsychotics. Atypical antipsychotic use was associated with increased odds of 30-day mortality (odds ratio [OR], 1.27; 95% CI, 1.16-1.38) and 90-day mortality (OR, 1.13; 95% CI, 1.01-1.27), after adjusting for potential confounders. 

The researchers also found increased odds of 30- and 90-day mortality in subgroups of patients with pre-existing psychiatric conditions (30-day OR, 1.13 [95% CI, 1.01-1.27] and 90-day OR, 1.12 [95% CI, 1.02-1.24]) and pre-existing cardiac conditions (30-day OR, 1.30 [95% CI, 1.14-1.48] and 90-day OR, 1.38 [95% CI 1.23-1.54]), respectively. 

However, the researchers found that atypical antipsychotics were not associated with increased odds of cardiovascular events (OR, 0.83; 95% CI, 0.75-0.91).

"Prior use of atypical antipsychotics [was] associated with an increased odds of mortality in [patients] 65 years or older [who] are hospitalized with pneumonia," the researchers concluded. "Therefore, clinicians should consider these findings when using atypical antipsychotics in those patients at risk for pneumonia."

Reference

Mortensen EM, Boivin Z, Perez MF, Atuegwu M, Metersky L. Association of atypical antipsychotics and mortality for patients hospitalized with pneumonia. Presented at: American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, CA. Abstract 2618.

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