Abstract：
BACKGROUND: In 2005, the Food and Drug Administration issued a black box warning regarding increased mortality and cardiovascular accidents with the off-label use of antipsychotic medication (APM) in patients with dementia. To improve the quality of care for patients with dementia in nursing homes (NH), in early 2012, the Centers for Medicare & Medicaid Services launched the National Partnership (NP) aimed at combatting the excessive use of APM. Within five years of the partnership, the number of antipsychotic prescriptions in NHs decreased by 34%. The objective of the present study was to examine how APM use has impacted other outcomes, including mortality and major cardiovascular events such as stroke and myocardial infarction (MI) among NH residents with dementia.
METHODS: We analyzed Medicare data on a sample of 611,773 long-term NH residents with dementia, aged 50 years and older, from 2011 through 2016. Residents who had received hospice care during the time period were excluded. Cross-sectional (by year) logistic regressions were conducted to examine the associations of APM use with death, stroke, and MI in the years 2011-2016. Regression models were adjusted for demographic and co-morbidity indicators.
RESULTS: Logistic regressions (see results in Table 1) revealed that NH residents prescribed APM had a significantly higher probability of death compared to non-users from 2011 through 2015. However, in 2016, the probability of death was lower among APM users than non-users, although the association was weak. Additionally, NH residents who were on APM were less likely to have a stroke or MI than non-users from 2011 through 2016.
CONCLUSIONS: Current study findings suggest that APM use is likely associated with a heightened probability of death among long-term NH residents, which is consistent with previous literature. The finding that APM use is negatively associated with stroke and MI is inconsistent with prevailing understandings that APM use would lead to higher risks of these outcomes. The shift in the likelihood of death in 2016, and negative associations with stroke and MI warrant further investigation as to the possible contributing factors of death and cardiovascular events in NH residents on antipsychotic medications.
METHODS: We analyzed Medicare data on a sample of 611,773 long-term NH residents with dementia, aged 50 years and older, from 2011 through 2016. Residents who had received hospice care during the time period were excluded. Cross-sectional (by year) logistic regressions were conducted to examine the associations of APM use with death, stroke, and MI in the years 2011-2016. Regression models were adjusted for demographic and co-morbidity indicators.
RESULTS: Logistic regressions (see results in Table 1) revealed that NH residents prescribed APM had a significantly higher probability of death compared to non-users from 2011 through 2015. However, in 2016, the probability of death was lower among APM users than non-users, although the association was weak. Additionally, NH residents who were on APM were less likely to have a stroke or MI than non-users from 2011 through 2016.
CONCLUSIONS: Current study findings suggest that APM use is likely associated with a heightened probability of death among long-term NH residents, which is consistent with previous literature. The finding that APM use is negatively associated with stroke and MI is inconsistent with prevailing understandings that APM use would lead to higher risks of these outcomes. The shift in the likelihood of death in 2016, and negative associations with stroke and MI warrant further investigation as to the possible contributing factors of death and cardiovascular events in NH residents on antipsychotic medications.
摘要：
背景：2005年，美国食品和药物管理局发布了一个黑匣子警告，关于痴呆症患者使用超标签抗精神病药物（APM）导致死亡率和心血管事故增加。为了提高养老院（NH）痴呆患者的护理质量，2012年初，医疗保险和医疗补助服务中心启动了国家伙伴关系（NP），旨在打击过度使用APM。在合作的五年内，NHs的抗精神病药物处方数量减少了34%.本研究的目的是检查APM的使用如何影响其他结果，包括死亡率和主要心血管事件，如中风和心肌梗死（MI）在NH居民痴呆。
方法：我们分析了611,773名患有痴呆症的长期NH居民的医疗保险数据，50岁及以上，从2011年到2016年。在此期间接受过临终关怀的居民被排除在外。进行了横断面（按年份）逻辑回归，以检查APM使用与死亡的关联。中风,和MI在2011-2016年。根据人口统计和合并症指标调整回归模型。
结果：Logistic回归（参见表1中的结果）显示，从2011年到2015年，与未使用APM的NH居民相比，使用APM的NH居民的死亡概率明显更高。然而,2016年，APM用户的死亡概率低于非用户，虽然协会很弱。此外,从2011年到2016年，接受APM的NH居民比非使用者患中风或MI的可能性较小。
结论：目前的研究结果表明，使用APM可能与长期NH居民的死亡概率增加有关，这与以前的文献是一致的。APM使用与卒中和MI负相关的发现与普遍的理解不一致，即APM使用会导致这些结果的风险更高。2016年死亡可能性的变化以及与中风和MI的负相关，需要进一步调查NH居民服用抗精神病药物的死亡和心血管事件的可能影响因素。
方法：我们分析了611,773名患有痴呆症的长期NH居民的医疗保险数据，50岁及以上，从2011年到2016年。在此期间接受过临终关怀的居民被排除在外。进行了横断面（按年份）逻辑回归，以检查APM使用与死亡的关联。中风,和MI在2011-2016年。根据人口统计和合并症指标调整回归模型。
结果：Logistic回归（参见表1中的结果）显示，从2011年到2015年，与未使用APM的NH居民相比，使用APM的NH居民的死亡概率明显更高。然而,2016年，APM用户的死亡概率低于非用户，虽然协会很弱。此外,从2011年到2016年，接受APM的NH居民比非使用者患中风或MI的可能性较小。
结论：目前的研究结果表明，使用APM可能与长期NH居民的死亡概率增加有关，这与以前的文献是一致的。APM使用与卒中和MI负相关的发现与普遍的理解不一致，即APM使用会导致这些结果的风险更高。2016年死亡可能性的变化以及与中风和MI的负相关，需要进一步调查NH居民服用抗精神病药物的死亡和心血管事件的可能影响因素。
