(289) To Use Antipsychotics or Not To Use Antipsychotics? A Population-Based Nested Case-Control Study in Patients with Hospital-Acquired Delirium After Discharge

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 620

Presenting Author(s)

Daniel Hsiang-Te Tsai, MClinPharm
– PhD student, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Centre for Neonatal and Paediatric Infection, Tainan, Tainan, Taiwan (Republic of China)

Co-Author(s)

Wei-Hung Chang
– MD, Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Tainan, Taiwan (Republic of China)
Edward Lai, PhD
– Associate Professor, National Cheng Kung University, National Cheng Kung University, Tainan City, Tainan, Taiwan (Republic of China)

Background: The question of whether to use antipsychotics in patients with hospital-acquired delirium after discharge, despite the debate for increased mortality, remained unanswered.

Objectives: To assess the association between the usage of antipsychotics in patients with hospital-acquired delirium after discharge and the risk of death.

Methods: Between 2011 and 2018, we used Taiwan's National Health Insurance Database (NHID) to conduct a nested case-control study. To avoid misclassification of delirium diagnosis, we included people diagnosed with hospital-acquired delirium while excluding those diagnosed with schizophrenia, bipolar illness, or depression. Case patients were individuals who died within 180 days after discharge, then control patients were matched with a ratio of up to 1:5 in age, sex, and days after discharge. We used conditional logistic regression models to calculate odds ratios (ORs) and 95 percent confidence intervals (CIs) on the mortality risk in patients with hospital-acquired delirium after discharge receiving antipsychotics compared to those who did not. Moreover, we considered variables reviewed from the literature as well as expert opinions. To examine the association, we stratified patients into two groups: those with dementia and those without. Furthermore, since QTc prolongation is a problem for patients on antipsychotics, we evaluated patients with arrhythmia to sort out the potential confounder.

Results: There were a total of 13,219 cases and 56,301 matched controls in this study. The average age was 79.2 (SD 13.1) years, and males accounted for 55 percent of the cohort. The use of antipsychotics after discharge did not raise the risk of death (adjusted OR, 1.03; 95 percent CI, 0.98-1.09). In particular, we revealed that those receiving haloperidol and a combination of two or more antipsychotics had greater crude mortality risks than controls; however, the risk differences were omitted when antipsychotic dosages and patients' baseline variables were taken into account. Despite stratifying by dementia or arrhythmia diagnosis, we demonstrated no association between the usage of antipsychotics and the risk of mortality.

Conclusions: Antipsychotic use in patients with hospital-acquired delirium after discharge was not related to an increased risk of mortality.