All-cause mortality and antipsychotic use among elderly persons with high baseline cardiovascular and cerebrovascular risk: a multi-center retrospective cohort study in Italy

ABSTRACT

Background: Little is known about the comparative risk of death with atypical or conventional antipsychotics (APs) among persons with cardiovascular or cerebrovascular disease (CCD).

Research design and methods: A cohort study was conducted using five Italian claims databases. New atypical AP users with CCD aged ≥65 (reference) were matched to new conventional AP users. Mortality per 100 person-years (PYs) and hazard ratios (HR), estimated using Cox models, were reported. Incidence and risk of death were estimated for persons having drug–drug interactions. Outcome occurrence was evaluated 180 days after AP initiation.

Results: Overall 24,711 and 27,051 elderly new conventional and atypical AP users were identified. The mortality rate was 51.3 and 38.5 deaths per 100 PYs for conventional and atypical AP users. Mortality risk was 1.33 (95%CI: 1.27–1.39) for conventional APs. There was no increased mortality risk with single drug–drug interactions (DDIs) vs. no DDI. AP users with ≥1 DDI had a 29% higher mortality risk compared to no DDI in the first 90 days of treatment (HR: 1.29 (95% CI: 1.00–1.67)).

Conclusions: Conventional APs had a higher risk of death than atypical APs among elderly persons with CCD. Having ≥1 DDI was associated with an increased risk of death.

KEYWORDS:

• Antipsychotics
• elderly
• mortality
• cohort study
• drug interactions

Author contributions

G Trifiro' conceived the study. F Giorgianni, J Sultana, and G Trifirò designed the study. F Giorgianni carried out data analysis. F Giorgianni, Janet Sultana, and G Trifiro' interpreted the results. F Rea, E Lucenteforte, J Sultana, N Lombardi, A Mugelli, A Vannacci, G Roberto, R Liperoti, U Kirchmayer, C Vitale, A Chinellato and G Corrao wrote and/or critically revised the manuscript.

Data availability statement

The dataset used to carry out the present study is not available in a public repository.

Declaration of interest

G Trifiro' coordinates an MSc programme for which his department has received funding from Baxter, Celgene, ABC pharmaceuticals, Amgen, MSD, Shire, Teva pharmaceuticals, unrelated to this study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Ethics approval

This study was approved by the Ethic Committee of the ‘“Azienda Ospedaliera Universitaria di Careggi”’, Florence, Italy, on 26 March, 2012; Protocol Number: 2012/0012643.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental material

Supplemental data for this article can be accessed here.

Additional information

Funding

The study was funded by the Italian Medicines Agency (project AIFA-FARM9LBBBL).