Association Between Psychotropic and Cardiovascular Iatrogenic Alerts and Risk of Hospitalizations in Elderly People Treated for Dementia: A Self-Controlled Case Series Study Based on the Matching of 2 French Health Insurance Databases.
BACKGROUND
Elderly people are at risk of repeated hospitalizations, some of which may be drug related and preventable. In 2011, a group of French healthcare experts selected 5 iatrogenic alerts (IAs), based on criteria identified in a literature search and from their professional experience, to assess the appropriateness of medication in elderly patients.


OBJECTIVE
Our objective was to examine the association between hospitalizations and IAs in elderly patients treated for Alzheimer disease who are particularly sensitive to adverse drug events.


METHODS
A 2-year (January 1, 2011, to December 31, 2012) longitudinal national database study, with a study design similar to self-controlled case series, was performed to analyze data on drug prescriptions and hospitalization. IAs were defined as (1) long half-life benzodiazepine; (2) antipsychotic drugs in patients with Alzheimer disease; (3) co-prescription of 3 or more psychotropic drugs; (4) co-prescription of 2 or more diuretics; and (5) co-prescription of 4 or more antihypertensive drugs. Data were obtained by matching of 2 French National Health Insurance Databases.


METHODS
France.


METHODS
All affiliates, aged ≥75 years, receiving treatment for Alzheimer disease, alive on January 1, 2011 were included.


METHODS
We calculated the relative increase in the number of hospitalizations in patients with IAs. The analysis was performed over four 6-month periods.


RESULTS
A total of 10,754 patients were included. During the periods with IAs, hospitalization rates increased by 0.36/year compared with 0.23/year in the periods without for the same patient, and the number of hospitalizations doubled [proportional fold change = 1.9, 95% confidence interval (1.8, 2.1)]. We estimated that 22% [95% confidence interval (20%, 23%)] of all hospitalizations were associated with IAs, 80% of which were due to psychotropic IAs.


CONCLUSIONS
The IAs could be used as a simple and clinically relevant tool by prescribing physicians to assess the appropriateness of the prescription in elderly patients treated for Alzheimer disease.
Université Sorbonne, Université Pierre et Marie Curie-Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR 1136, Paris, France; Université Sorbonne, Université Pierre et Marie Curie-Paris 06, Biological adaptation and Aging, INSERM, UMR 8256, Paris, France; Assistance Publique Hopitaux de Paris, Pitié-Salpêtrière Hospital, Geriatric Department, Paris, France. Electronic address: Lorene.zerah@aphp.fr.
Lorene
L
Zerah
Université Sorbonne, Université Pierre et Marie Curie-Paris 06, Biological adaptation and Aging, INSERM, UMR 8256, Paris, France; Assistance Publique Hopitaux de Paris, Pitié-Salpêtrière Hospital, Geriatric Department, Paris, France; University Hospital Department Fight Aging and Stress (DHU FAST), APHP, Paris, France.
Jacques
J
Boddaert
Haute Autorité de Santé (French National Authority For Health), Saint Denis La Plaine, France.
Armelle
A
Leperre-Desplanques
OMEDIT- Ile de France (Observatory of Drugs, Medical Devices, and Therapeutic Innovations), Paris, France; APHP, Centre de Pharmaco-épidémiologie, Paris, France.
Dominique
D
Bonnet-Zamponi
Université Sorbonne, Université Pierre et Marie Curie-Paris 06, Biological adaptation and Aging, INSERM, UMR 8256, Paris, France; Assistance Publique Hopitaux de Paris, Pitié-Salpêtrière Hospital, Geriatric Department, Paris, France; University Hospital Department Fight Aging and Stress (DHU FAST), APHP, Paris, France.
Marc
M
Verny
Régime Social des Indépendants, Saint Denis La Plaine, France.
Jean
J
Deligne
Université Sorbonne, Université Pierre et Marie Curie-Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR 1136, Paris, France; APHP, Saint-Antoine Hospital, Public Health Department, Paris, France.
Pierre-Yves
PY
Boelle
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy*; D016022:Case-Control Studies; D016208:Databases, Factual; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005602:France; D006760:Hospitalization; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000627:therapeutic use*; D018570:Risk Assessment
D011619:Psychotropic Drugs
Iatrogenic alert; adverse drug event; self-controlled analysis