Antipsychotics up risk of death, cardiopulmonary arrest in hospitalized adults

The use of antipsychotic medications may increase mortality or cardiopulmonary arrest risk in hospitalized adults, a recent study has shown.

Researchers retrospectively assessed 150,948 hospitalizations for the influence of typical (n=1,419) and atypical (n=9,169) antipsychotic administration on clinical outcomes, such as deaths and cardiopulmonary arrests. Majority (n=139,098) of these were unexposed. Antipsychotic classification was based on Food and Drug Administration guidelines.

There were 691 outcome events reported, 515 of which were deaths and the remaining 176 were cardiopulmonary arrest episodes. Events were more frequent in patients exposed to typical (2.5 percent) and atypical (0.9 percent) antipsychotics, as well as to both (2.2 percent), relative to those who were unexposed (0.4 percent).

In absolute terms, patients who were exposed to antipsychotics experienced 0.15 events per 100 hospitalization-days, as opposed to only 0.08 per 100 hospitalization-days in the unexposed arm.

Cox proportional hazards analysis, adjusted for time-dependent and fixed variables, showed that typical antipsychotic medication significantly increased the risk of cardiopulmonary arrest or death relative to those who were not exposed to such drugs (hazard ratio [HR], 1.6, 95 percent confidence intervals [CI], 1.1–2.4). Atypical agents, on the other hand, had no such effect (HR, 1.1, 95 percent CI, 0.8–1.4).

“[I]n a cohort of hospitalized adults from a large academic medical centre, typical antipsychotic exposure was significantly associated with in-hospital death or cardiopulmonary arrest,” said researchers. “Inpatient providers should be thoughtful when prescribing antipsychotic medications, especially in settings where few data are available regarding benefit.”