Off-brand antipsychotic use on the rise among elderly heart patients
More than 6 percent of elderly patients are given antipsychotic drugs after heart surgery, according to findings from a study published Aug. 19 in the Journal of the American Geriatrics Society. Researchers are noting a disturbing trend in the use of off-brand medications they think might harm patients more than help them.
It’s not uncommon for older patients to receive antipsychotic medications (APMs) post-heart surgery, first author Dae Hyun Kim, MD, MPH, ScD, and colleagues wrote. The researchers estimated nearly 10,000 such patients are prescribed the drugs each year to combat the delirium that often follows cardiac surgery. But there’s no evidence backing APMs as effective for treating delirium, and some studies have warned the drugs can be dangerous.
“Clinical trials have not consistently demonstrated that APMs reduce delirium incidence, duration or severity, and observational studies and clinical trials in older adults with dementia have found that APMs increase the risk of sedation, extrapyramidal symptoms, cardiac arrhythmia, stroke, pneumonia and even death,” Kim, of Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center in Boston, Massachusetts, and co-authors wrote. “Older adults undergoing cardiac surgery are susceptible to these adverse events.”
The team conducted a retrospective cohort study to assess the current state of APM prescriptions in older cardiac patients using information from the Premier Healthcare Database. Kim et al. reviewed data from patients 65 years and up who’d had either coronary artery bypass surgery, heart valve surgery, or both at one of more than 700 hospitals between 2004 and 2014.
According to the authors’ analysis, older adults were typically given antipsychotics for around five days, with 15.5 percent of the study pool having received them for more than a week. Just over 6 percent of all patients reported having been given APMs after heart surgery—almost 10,000 patients annually.
Kim and colleagues said haloperidol was the most commonly prescribed “typical” APM, though the study also accounted for “atypical” antipsychotic drugs like olanzapine, quetiapine, risperidone, aripiprazole and ziprasidone. Use of off-brand APMs, they said, particularly quetiapine, seems to be increasing.
“Although haloperidol was the most commonly prescribed APM, we observed a shift in choice of atypical APMs from risperidone to quetiapine,” the authors wrote. “The steep increase in quetiapine use and consistently high rate of potentially excessive dosing of haloperidol are worrisome, particularly in light of recent guidelines highlighting the lack of consistent evidence of the benefit of APMs for delirium and their potential harm.”
The researchers said more research is needed to determine whether decreased APM use would result in greater use or heavier dosing of other treatments, like benzodiazepines or hypnotics.
“To promote appropriate APM prescribing and improve clinical outcomes of older adults undergoing cardiac surgery, high-quality evidence on the effectiveness and harm of APMs for management of delirium and training of healthcare providers about effective nonpharmacological interventions are urgently needed,” they wrote.
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.