Antipsychotic use in older adults after heart surgery

August 21, 2018

Delirium is the medical term for an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. Delirium can cause you to become confused, potentially aggressive, agitated, sleepy, and/or inactive. Post-operative delirium can occur after you've had an operation, and is the most common complication older adults experience after they have surgery. Older adults are at high risk for post-operative delirium after they have heart surgery.

When older adults have post-operative delirium, they are often given antipsychotic medications (APMs). However, these drugs are not proven to be effective for treating delirium and may be harmful. Experts suggest that these drugs do not reduce how often or for how long older adults may experience delirium, or how serious the effects of delirium may be.

Additionally, some studies in older adults with dementia have found that APMs may cause heart rhythm problems and other drug-related side effects. Taking these drugs can increase the effects of anesthesia, and can cause stroke, pneumonia, and even death. Older adults who have had heart surgery are more likely to experience these dangerous events.

In a new study published in the Journal of the American Geriatrics Society, researchers looked into the use of APMs in older adults following heart surgery.

The research team used information from the Premier Healthcare Database. It contains information about people treated at more than 700 hospitals. The researchers reviewed information from 2004 to 2014 to examine the use of antipsychotic medications in people 65-years-old and older who had coronary artery bypass surgery, heart valve surgery, or both.

Medications included were haloperidol (considered a "typical" antipsychotic drug), and newer "atypical" antipsychotic drugs such as olanzapine, quetiapine, risperidone, aripiprazole and ziprasidone.

The older adults were given the antipsychotic medications for about 4.6 days, and 15.5 percent of study participants received them for more than 7 days.

The researchers learned that 6.2 percent of patients were given antipsychotic medications after heart surgery, which equals almost 10,000 patients each year. Haloperidol was the most commonly prescribed "typical" APM. However, the researchers said that the use of the newer antipsychotic quetiapine was becoming more common.

The researchers said that "the steep increase in quetiapine use and the excessive dosing of haloperidol are worrisome, particularly in light of recent guidelines which highlighted the lack of evidence of the benefit of APMs for delirium, as well as their potential harm." The researchers concluded that their results show the need to promote more appropriate antipsychotic use following heart surgery.
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This summary is from "Longitudinal Trends and Variation in Antipsychotic Use in Older Patients After Cardiac Surgery." It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Dae Hyun Kim, MD, MPH, ScD; Mufaddal Mahesri, MD, MPH; Brian T. Bateman, MD, SM; Krista F. Huybrechts, MS, PhD; Sharon K. Inouye, MD, MPH; Edward R. Marcantonio, MD, SM; Shoshana J. Herzig, MD, MPH; E. Wesley Ely, MD, MPH; Margaret A. Pisani, MD, MPH; Raisa Levin, MS; and Jerry Avorn, MD.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

About the Journal of the American Geriatrics Society

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org
American Geriatrics Society

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