Associations between COVID-19 and 30-day thromboembolic events and mortality in people with dementia receiving antipsychotic medications

• Published in: Pharmacological research 2021-05, Vol.167, p.105534-105534, Article 105534
• Main Authors: Harrison, Stephanie L., Buckley, Benjamin J.R., Lane, Deirdre A., Underhill, Paula, Lip, Gregory Y.H.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Alzheimer’s disease; Antipsychotic Agents - adverse effects; Antipsychotics; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - mortality; Dementia; Dementia - diagnosis; Dementia - drug therapy; Dementia - mortality; Dementia - psychology; Electronic Health Records; Female; Humans; Male; Mortality; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Thromboembolism - diagnosis; Thromboembolism - epidemiology; Thromboembolism - mortality; Time Factors
• ISSN: 1043-6618; 1096-1186
• DOI: 10.1016/j.phrs.2021.105534

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. 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. 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