Abstract
Objective: Examine whether new antipsychotic (AP) exposure is associated with dysphagia in hospitalized patients with heart failure (HF). Design: Retrospective cohort. Settings and Participants: AP-naïve Veterans hospitalized with HF and subsequently discharged to a skilled nursing facility (SNF) between October 1, 2010, and November 30, 2019. Methods: We linked Veterans Health Administration (VHA) electronic medical records with Centers for Medicare & Medicaid (CMS) Minimum Data Set (MDS) version 3.0 assessments and CMS claims. The exposure variable was administration of ≥1 dose of a typical or atypical AP during hospitalization. Our main outcome measure was dysphagia presence defined by (1) inpatient dysphagia diagnosis codes and (2) the SNF admission MDS 3.0 swallowing-related items to examine post-acute care dysphagia status. Inverse probability of treatment weighting was used for risk adjustment. Results: The analytic cohort consisted of 29,591 Veterans (mean age 78.5 ± 10.0 years; female 2.9%; n = 865). Acute APs were administered to 9.9% (n = 2941). Those receiving APs had differences in prior dementia [37.1%, n = 1091, vs 22.3%, n = 5942; standardized mean difference (SMD) = 0.33] and hospital delirium diagnoses (7.7%, n = 227 vs 2.8%, n = 754; SMD = 0.22). Acute AP exposure was associated with nearly double the risk for hospital dysphagia diagnosis codes [adjusted (adj.) relative risk (RR) 1.9, 95% CI 1.8, 2.1]. At the SNF admission MDS assessment, acute AP administration during hospitalization was associated with an increased dysphagia risk (adj. RR 1.2, 95% CI 1.0, 1.5) both in the oral (adj. RR 1.7, 95% CI 1.2, 2.0) and pharyngeal phases (adj. RR 1.3, 95% CI 1.0, 1.7). Conclusions and Implications: In this retrospective study, AP medication exposure was associated with increased dysphagia coding and MDS assessment. Considering other adverse effects, acute AP should be cautiously administered during hospitalization, particularly in those with dementia. Swallowing function is critical to hydration, nutrition, and medical management of HF; therefore, when acute APs are initiated, a swallow evaluation should be considered.
| Original language | English |
|---|---|
| Pages (from-to) | 1303-1310 |
| Number of pages | 8 |
| Journal | Journal of the American Medical Directors Association |
| Volume | 24 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 2023 |
Bibliographical note
Publisher Copyright:© 2023
Funding
Some authors are Veterans Affairs employees (M.S., L.J., M.D., J.E.M., A.Z., J.L.R., and N.M.R-P). The content and views expressed in this article are those of the authors and do not necessarily reflect the position or official policies of the United States Government or the US Department of Veterans Affairs. This work was also partially supported by the William S. Middleton Veteran Affairs Hospital , Madison, WI (N.R.-P., GRECC Manuscript 007-2023), and the National Institute on Aging ( 8K00AG076123 to R.R.; R21AG061632 , R01AG065722 , RF1AG061221 , R24AG064025 , and R01AG062492 to A.Z.; and 1K76AG068590 to N.R.-P.). R.R., N.R.-P., A.Z., and J.L.R. have also received material or salary support from the National Institute on Aging ( P01AG027296 ). The funding organizations were not involved in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Some authors are Veterans Affairs employees (M.S., L.J., M.D., J.E.M., A.Z., J.L.R., and N.M.R-P). The content and views expressed in this article are those of the authors and do not necessarily reflect the position or official policies of the United States Government or the US Department of Veterans Affairs. This work was also partially supported by the William S. Middleton Veteran Affairs Hospital, Madison, WI (N.R.-P., GRECC Manuscript 007-2023), and the National Institute on Aging (8K00AG076123 to R.R.; R21AG061632, R01AG065722, RF1AG061221, R24AG064025, and R01AG062492 to A.Z.; and 1K76AG068590 to N.R.-P.). R.R., N.R.-P., A.Z., and J.L.R. have also received material or salary support from the National Institute on Aging (P01AG027296). The funding organizations were not involved in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.The authors declare the following potential conflicts of interest: A.Z. receives grant funding from Sanofi Pasteur directly paid to Brown University for research on infections and vaccinations in nursing home residents and infants. P.G. is supported by American Heart Association grant 20CDA35310455 and receives personal fees for medicolegal consulting related to heart failure and has received honoraria from Akcea Therapeutics inc and Bionest Inc. The authors declare the following potential conflicts of interest: A.Z. receives grant funding from Sanofi Pasteur directly paid to Brown University for research on infections and vaccinations in nursing home residents and infants. P.G. is supported by American Heart Association grant 20CDA35310455 and receives personal fees for medicolegal consulting related to heart failure and has received honoraria from Akcea Therapeutics inc and Bionest Inc.
| Funders | Funder number |
|---|---|
| Akcea Therapeutics inc and Bionest Inc. | |
| William S. Middleton Veteran Affairs Hospital | |
| National Institute on Aging | R01AG065722, P01AG027296, 1K76AG068590, R21AG061632, R01AG062492, RF1AG061221, 8K00AG076123, R24AG064025 |
| U.S. Department of Veterans Affairs | |
| American the American Heart Association | 20CDA35310455 |
| Geriatric Research Education and Clinical Center | Manuscript 007-2023 |
Keywords
- Antipsychotics
- dysphagia
- heart failure
- swallowing
ASJC Scopus subject areas
- General Nursing
- Health Policy
- Geriatrics and Gerontology
