Post-Stroke Mortality, Stroke Severity, and Preadmission Antipsychotic Medicine Use – A Population-Based Cohort Study

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Post-Stroke Mortality, Stroke Severity, and Preadmission Antipsychotic Medicine Use – A Population-Based Cohort Study. / Prior, Anders; Laursen, Thomas Munk; Larsen, Karen Kjær; Johnsen, Søren Paaske; Christensen, Jakob; Andersen, Grethe; Vestergaard, Mogens.

In: PLOS ONE, Vol. 9, No. 1, 08.01.2014, p. e84103.

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@article{58d49fa404c44dca95b79342680766d4,
title = "Post-Stroke Mortality, Stroke Severity, and Preadmission Antipsychotic Medicine Use – A Population-Based Cohort Study",
abstract = "Background and Purpose:It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use.Methods: We conducted a nationwide, population-based cohort study of 81,143 persons admitted with stroke in Denmark from 2003–2010. Using Danish health care databases, we extracted data on preadmission use of antipsychotics and confounding factors. We examined the association between current, former, and never use of antipsychotics and stroke severity, length of hospital stay, and 30-day post-stroke mortality using logistic regression analysis, survival analysis, and propensity score matching. Results: Current users of antipsychotics had a higher risk of severe or very severe stroke on The Scandinavian Stroke Scale than never users of antipsychotics (adjusted odds ratios, 1.43; 95{\%} CI, 1.29–1.58). Current users were less likely to be discharged from hospital within 30 days of admission than never users (probability of non-discharge, 27.0{\%} vs. 21.9{\%}). Antipsychotics was associated with an increased 30-day post-stroke mortality among current users (adjusted mortality rate ratios, 1.42; 95{\%} CI, 1.29–1.55), but not among former users (adjusted mortality rate ratios, 1.05; 95{\%} CI, 0.98–1.14).Conclusions: Preadmission use of antipsychotics was associated with a higher risk of severe stroke, a longer duration of hospital stay, and a higher post-stroke mortality, even after adjustment for known confounders. Antipsychotics play an important role in the treatment of many psychiatric conditions, but our findings do not support the hypothesis that they reduce stroke severity or post-stroke mortality.",
keywords = "Stroke, Antipsychotic Agents, Mortality, Neurology, Survival, Neuroprotective Agents",
author = "Anders Prior and Laursen, {Thomas Munk} and Larsen, {Karen Kj{\ae}r} and Johnsen, {S{\o}ren Paaske} and Jakob Christensen and Grethe Andersen and Mogens Vestergaard",
year = "2014",
month = "1",
day = "8",
doi = "10.1371/journal.pone.0084103",
language = "English",
volume = "9",
pages = "e84103",
journal = "P L o S One",
issn = "1932-6203",
publisher = "public library of science",
number = "1",

}

RIS

TY - JOUR

T1 - Post-Stroke Mortality, Stroke Severity, and Preadmission Antipsychotic Medicine Use – A Population-Based Cohort Study

AU - Prior, Anders

AU - Laursen, Thomas Munk

AU - Larsen, Karen Kjær

AU - Johnsen, Søren Paaske

AU - Christensen, Jakob

AU - Andersen, Grethe

AU - Vestergaard, Mogens

PY - 2014/1/8

Y1 - 2014/1/8

N2 - Background and Purpose:It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use.Methods: We conducted a nationwide, population-based cohort study of 81,143 persons admitted with stroke in Denmark from 2003–2010. Using Danish health care databases, we extracted data on preadmission use of antipsychotics and confounding factors. We examined the association between current, former, and never use of antipsychotics and stroke severity, length of hospital stay, and 30-day post-stroke mortality using logistic regression analysis, survival analysis, and propensity score matching. Results: Current users of antipsychotics had a higher risk of severe or very severe stroke on The Scandinavian Stroke Scale than never users of antipsychotics (adjusted odds ratios, 1.43; 95% CI, 1.29–1.58). Current users were less likely to be discharged from hospital within 30 days of admission than never users (probability of non-discharge, 27.0% vs. 21.9%). Antipsychotics was associated with an increased 30-day post-stroke mortality among current users (adjusted mortality rate ratios, 1.42; 95% CI, 1.29–1.55), but not among former users (adjusted mortality rate ratios, 1.05; 95% CI, 0.98–1.14).Conclusions: Preadmission use of antipsychotics was associated with a higher risk of severe stroke, a longer duration of hospital stay, and a higher post-stroke mortality, even after adjustment for known confounders. Antipsychotics play an important role in the treatment of many psychiatric conditions, but our findings do not support the hypothesis that they reduce stroke severity or post-stroke mortality.

AB - Background and Purpose:It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use.Methods: We conducted a nationwide, population-based cohort study of 81,143 persons admitted with stroke in Denmark from 2003–2010. Using Danish health care databases, we extracted data on preadmission use of antipsychotics and confounding factors. We examined the association between current, former, and never use of antipsychotics and stroke severity, length of hospital stay, and 30-day post-stroke mortality using logistic regression analysis, survival analysis, and propensity score matching. Results: Current users of antipsychotics had a higher risk of severe or very severe stroke on The Scandinavian Stroke Scale than never users of antipsychotics (adjusted odds ratios, 1.43; 95% CI, 1.29–1.58). Current users were less likely to be discharged from hospital within 30 days of admission than never users (probability of non-discharge, 27.0% vs. 21.9%). Antipsychotics was associated with an increased 30-day post-stroke mortality among current users (adjusted mortality rate ratios, 1.42; 95% CI, 1.29–1.55), but not among former users (adjusted mortality rate ratios, 1.05; 95% CI, 0.98–1.14).Conclusions: Preadmission use of antipsychotics was associated with a higher risk of severe stroke, a longer duration of hospital stay, and a higher post-stroke mortality, even after adjustment for known confounders. Antipsychotics play an important role in the treatment of many psychiatric conditions, but our findings do not support the hypothesis that they reduce stroke severity or post-stroke mortality.

KW - Stroke

KW - Antipsychotic Agents

KW - Mortality

KW - Neurology

KW - Survival

KW - Neuroprotective Agents

U2 - 10.1371/journal.pone.0084103

DO - 10.1371/journal.pone.0084103

M3 - Journal article

VL - 9

SP - e84103

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 1

ER -