Antidepressant use, but not polypharmacy, is associated with worse outcomes after in-hospital cardiac arrest in older people

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care Pub Date : 2025-02-08 DOI:10.1016/j.aucc.2025.101201

Gustavo Martins Ferreira BN , João Carlos Clarck Barros BN , Nayane Maria Vieira MN , Isabelle de Almeida Souza BN , Asiya Shalova BN , Bertha Furlan Polegato MD, PhD , Leonardo Antônio Mamede Zornoff MD, PhD , Sergio Alberto Rupp de Paiva MD, PhD , Paulo José Fortes Villas Boas MD, PhD , Danilo Martins MD, PhD , Edson Luiz Favero Junior MD, PhD , Taline Lazzarin MD , Jemima Collins MD, PhD , Paula Schmidt Azevedo MD, PhD , Marcos Ferreira Minicucci MD, PhD

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引用次数: 0

Abstract

Background

It is already known that age and some chronic diseases are associated with worse outcomes after in-hospital cardiac arrest (IHCA). Usually, patients with two or more chronic diseases are treated with multiple medicines, which is commonly referred as polypharmacy (five or more medications). The objective of this study was to evaluate the association between polypharmacy and antidepressant use before hospital admission with return of spontaneous circulation (ROSC) and in-hospital mortality in IHCA.

Methods

This retrospective study included patients over 18 years of age with IHCA, attended by the rapid response team in hospital wards, from March 2018 to September 2023. The exclusion criteria were the absence of information regarding polypharmacy, pregnancy, and the presence of an express “do-not-resuscitate order”. Data were collected from the electronic medical records.

Results

A total of 578 patients with IHCA were evaluated; 42 patients were excluded due to the absence of information regarding polypharmacy and 24 due to “natural death permission”. Thus, we included 512 patients in the analysis. The mean age was 64.4 ± 14.9 years; 52.3% were male, and 54.5% were older people. Polypharmacy was prescribed for 50.8% of patients, 48.4% had ROSC, and in-hospital mortality was 92.0%. In logistic regression models, the polypharmacy regimen use in the older population was not associated with ROSC (odds ratio [OR]: 1.122; 95% confidence interval [CI]: 0.660–1.906; p: 0.672) or mortality (OR: 1.185; 95% CI: 0.170–8.260; p: 0.864). Regarding antidepressant use, it was associated with lower rates of ROSC (OR: 0.412; 95% CI: 0.183–0.925; p: 0.032) but was not associated with mortality in older people (OR: 1.682; 95% CI: 0.129–21.996; p: 0.692).

Conclusions

In conclusion, polypharmacy regimen was not associated with ROSC and in-hospital mortality; however, antidepressant use was associated with lower rates of ROSC only in older patients.

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抗抑郁药的使用，而不是多种药物，与老年人住院后心脏骤停的不良结果相关

背景已经知道年龄和一些慢性疾病与院内心脏骤停（IHCA）后的不良结果相关。通常，患有两种或两种以上慢性病的患者使用多种药物治疗，这通常被称为多药（五种或五种以上药物）。本研究的目的是评估IHCA患者入院前使用多种药物和抗抑郁药与自发循环恢复（ROSC）和住院死亡率之间的关系。方法回顾性研究纳入2018年3月至2023年9月在医院病房由快速反应小组就诊的18岁以上IHCA患者。排除标准是缺乏关于多药、妊娠和存在明确的“不复苏令”的信息。数据是从电子病历中收集的。结果共评估578例IHCA患者；42名患者因缺乏有关多种药物的信息而被排除在外，24名患者因“自然死亡许可”而被排除在外。因此，我们纳入了512例患者。平均年龄64.4±14.9岁；男性占52.3%，老年人占54.5%。50.8%的患者使用多种药物，48.4%的患者有ROSC，住院死亡率为92.0%。在logistic回归模型中，老年人群中多药方案的使用与ROSC无关(比值比[OR]: 1.122；95%置信区间[CI]: 0.66 - 1.906；p: 0.672)或死亡率(or: 1.185；95% ci: 0.170-8.260；p: 0.864)。关于抗抑郁药的使用，与较低的ROSC率相关(OR: 0.412；95% ci: 0.183-0.925；p: 0.032)，但与老年人的死亡率无关(OR: 1.682；95% ci: 0.129-21.996；p: 0.692)。结论综合用药方案与ROSC及院内死亡率无相关性；然而，只有在老年患者中，抗抑郁药的使用与较低的ROSC发生率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.