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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.
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Risk of Serious Cardiac Events in Older Adults Using Antipsychotic AgentsSandhya Mehta, MS; Hua Chen, MD, PhD; Michael Johnson, PhD; and Rajender R. Aparasu, MPharm, PhDAm J Geriatr Pharmacother. 2011; 9: 120-132 Alicia Williams 2012 PharmD Candidate Mercer University COPHS July 7, 2011
Typical Antipsychotics • loxapine • fluphenazine • triflupromazine • chlorprothixene • haloperidol • chlorpromazine • thioridazine • prochlorperazine • promazine • trifluperazine • thiothexene • molindone • perphenazine • acetophenazine • mesoridazine • paliperidone • pimozide • perphenazine-amitriptyline
Atypical Antipsychotics • clozapine • olanzapine • risperidone • quetiapine • ziprasidone • aripiprazole
Background • Antipsychotic agents can cause cardiovascular events through multiple mechanisms: • prolongation of the QT interval • causes orthostasis and tachyarrhythmias • Torsade de pointes • raised lupus anticoagulant and anticardiolipin antibody levels • can lead to increased risk of venous thromboembolism • increased occurrence of metabolic syndrome such as type 2 diabetes, weight gain, and hypertriglyceridemia
Objective • To compare the risk of serious cardiac events in older adults taking typical antipsychotics with those taking atypical antipsychotics
Study Design • 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 • Participants must have been continuously eligible 6 months before and 6 months after the index date • Index date: • 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. • maximum: 1 year
Patient Demographics • A total of 5580 patients were selected in each antipsychotic users group after propensity score matching.
Intervention • 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 • Hospitalizations or emergency room visit due to serious cardiac events, including: • thromboembolism, • myocardial infarction, • cardiac arrest, • ventricular arrhythmias, within one year after the index date
Results • Serious cardiac events were found in: • 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 • hazard ratio = 1.21; 95% CI, 1.04-1.40
Conclusion • 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 benefit-to-risk ratio of antipsychotics before prescribing them to a vulnerable population such as the elderly.
Comment • 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.
