Harrison, SL, Buckley, BJR, Lane, DA, Underhill, P and Lip, GYH (2021) Associations between COVID-19 and 30-day thromboembolic events and mortality in people with dementia receiving antipsychotic medications. Pharmacological Research, 167. ISSN 1043-6618

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Abstract

Background: Antipsychotic medications are frequently prescribed to people with dementia to manage behavioural and psychological symptoms. Using a global federated research network, the objectives were to determine: 1) if COVID-19 is associated with 30-day thromboembolic events and mortality for people with dementia receiving antipsychotic medications; and 2) if the proportion of people with dementia receiving antipsychotics is higher during the COVID-19 pandemic compared to 2019. Methods: A retrospective cohort study was conducted using TriNetX, a global federated health research network. The network was searched for people aged ≥ 65 years with dementia, COVID-19 and use of antipsychotics in the 30-days prior to COVID-19 recorded in electronic medical records between 20/01/2020 and 05/12/2020. These individuals were compared to historical controls from 2019 with dementia and use of antipsychotics in the 30-days before a visit to a participating healthcare organisation. Propensity score matching for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants was used to balance cohorts with and without COVID-19. Results: Within the TriNetX network, 8414 individuals with COVID-19, dementia and use of antipsychotics and 31,963 historical controls were identified. After propensity score matching there were 8396 individuals with COVID-19 and 8396 historical controls. The cohorts were well balanced for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants. The odds of 30-day thromboembolic events and all-cause mortality were significantly higher in adults with COVID-19 (Odds Ratios: 1.36 (95% confidence interval (CI): 1.21–1.52) and 1.93 (1.71–2.17), respectively). The number of people with dementia with a visit to a participating healthcare organisation was lower between 20/01/2020 and 05/12/2020 (n = 165,447) compared to the same period in 2019 (n = 217,391), but the proportion receiving antipsychotics increased from 14.7% (95%CI: 14.6–14.9%) to 16.4% (95%CI: 16.2–16.5%), P < .0001. Conclusions: These findings add to the evidence base that during the COVID-19 pandemic there was an increase in the proportion of people with dementia receiving antipsychotics. The negative effects of antipsychotics in patients with dementia may be compounded by concomitant COVID-19.

Item Type:	Article
Uncontrolled Keywords:	Science & Technology; Life Sciences & Biomedicine; Pharmacology & Pharmacy; Dementia; Alzheimer's disease; Antipsychotics; COVID-19; Mortality; MANAGEMENT; SYMPTOMS; Humans; Dementia; Thromboembolism; Antipsychotic Agents; Prognosis; Risk Assessment; Risk Factors; Retrospective Studies; Time Factors; Aged; Aged, 80 and over; Female; Male; Electronic Health Records; COVID-19; Alzheimer’s disease; Antipsychotics; COVID-19; Dementia; Mortality; Aged; Aged, 80 and over; Antipsychotic Agents; COVID-19; Dementia; Electronic Health Records; Female; Humans; Male; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Thromboembolism; Time Factors; Pharmacology & Pharmacy; 1115 Pharmacology and Pharmaceutical Sciences
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport & Exercise Sciences
Publisher:	Elsevier
SWORD Depositor:	A Symplectic
Date Deposited:	17 May 2022 13:22
Last Modified:	17 May 2022 13:30
DOI or ID number:	10.1016/j.phrs.2021.105534
URI:	https://researchonline.ljmu.ac.uk/id/eprint/16826

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