Continuation of atypical antipsychotic medications in critically ill patients discharged from the hospital: a single-center retrospective analysis

Background: Atypical antipsychotics (AAP) have been associated with reduced duration of delirium in the intensive care setting. However, long-term use of these drugs is associated with significant adverse events, including increased all-cause mortality in the elderly. Inappropriate continuation of AAPs after discharge from the intensive care unit (ICU) is worrisome and needs to be addressed. The aim of this work was to assess the prevalence of continuation of AAPs after hospital discharge and evaluate the associated risk factors. Method: This was a single-center retrospective chart analysis in the setting of adult ICUs at a tertiary care academic medical center. It involved all adult patients admitted to the ICU and initiated on AAPs from January 2012 to December 2014. The measurements were: (1) prevalence of ICU-initiated AAP continuation following hospital discharge, (2) risk factors associated with continuation of AAPs following hospital discharge, and (3) risk of continuation of AAPs in patients ⩾65 years of age. Results: A total of 55% of ICU patients initiated on AAPs were discharged from the hospital with a prescription for continued AAP therapy. Male sex and discharge location were highly associated with continuation upon discharge. Older patients (⩾65 years of age) were not at a higher risk of being continued on these drugs after discharge. Conclusion: Male sex and discharge to a healthcare facility were associated with a higher rate of continuation. Research into practical methods to reduce their continuation upon discharge should be performed to mitigate the long-term risks of AAP administration.