Proton pump inhibitors and risk of 1-year mortality and rehospitalization in older patients discharged from acute care hospitals

Marcello Maggio, Andrea Corsonello, Gian Paolo Ceda, Chiara Cattabiani, Fulvio Lauretani, Valeria Buttò, Luigi Ferrucci, Stefania Bandinelli, Angela Marie Abbatecola, Liana Spazzafumo, Fabrizia Lattanzio

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Importance: The use of proton pump inhibitors (PPIs) has rapidly increased during the past several years. However, concern remains about risks associated with their long-term use in older populations. Objective: To investigate the relationship between the use of PPIs and the risk of death or the combined end point of death or rehospitalization in older patients discharged from acute care hospitals. Design: We investigated the relationship between PPI use and study outcomes using time-dependent Cox proportional hazards regression in patients 65 years or older discharged from acute care medical wards from April 1 to June 30, 2007. Setting: Eleven acute care medical wards. Participants: Four hundred ninety-one patients (mean [SD] age, 80.0 [5.9] years). Main Outcome Measures: Mortality and the combined end point of death or rehospitalization. Results: The use of PPIs was independently associated with mortality (hazard ratio, 1.51 [95% CI, 1.03-2.77]) but not with the combined end point (1.49 [0.98-2.17]). An increased risk of mortality was observed among patients exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95% CI, 1.22-7.16]). Conclusions and Relevance: In older patients discharged from acute care hospitals, the use of high-dose PPIs is associated with increased 1-year mortality. Randomized controlled studies including older frail patients are needed. In the meantime, physicians need to use caution and balance benefits and harms in longterm prescription of high-dose PPIs.

Original languageEnglish
Pages (from-to)518-523
Number of pages6
JournalJAMA Internal Medicine
Volume173
Issue number7
DOIs
Publication statusPublished - Apr 8 2013

Fingerprint

Proton Pump Inhibitors
Mortality
Outcome Assessment (Health Care)
Prescriptions
Physicians
Population

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Proton pump inhibitors and risk of 1-year mortality and rehospitalization in older patients discharged from acute care hospitals. / Maggio, Marcello; Corsonello, Andrea; Ceda, Gian Paolo; Cattabiani, Chiara; Lauretani, Fulvio; Buttò, Valeria; Ferrucci, Luigi; Bandinelli, Stefania; Abbatecola, Angela Marie; Spazzafumo, Liana; Lattanzio, Fabrizia.

In: JAMA Internal Medicine, Vol. 173, No. 7, 08.04.2013, p. 518-523.

Research output: Contribution to journalArticle

Maggio, Marcello ; Corsonello, Andrea ; Ceda, Gian Paolo ; Cattabiani, Chiara ; Lauretani, Fulvio ; Buttò, Valeria ; Ferrucci, Luigi ; Bandinelli, Stefania ; Abbatecola, Angela Marie ; Spazzafumo, Liana ; Lattanzio, Fabrizia. / Proton pump inhibitors and risk of 1-year mortality and rehospitalization in older patients discharged from acute care hospitals. In: JAMA Internal Medicine. 2013 ; Vol. 173, No. 7. pp. 518-523.
@article{b6d3bd306dd447d086b5556843eb468a,
title = "Proton pump inhibitors and risk of 1-year mortality and rehospitalization in older patients discharged from acute care hospitals",
abstract = "Importance: The use of proton pump inhibitors (PPIs) has rapidly increased during the past several years. However, concern remains about risks associated with their long-term use in older populations. Objective: To investigate the relationship between the use of PPIs and the risk of death or the combined end point of death or rehospitalization in older patients discharged from acute care hospitals. Design: We investigated the relationship between PPI use and study outcomes using time-dependent Cox proportional hazards regression in patients 65 years or older discharged from acute care medical wards from April 1 to June 30, 2007. Setting: Eleven acute care medical wards. Participants: Four hundred ninety-one patients (mean [SD] age, 80.0 [5.9] years). Main Outcome Measures: Mortality and the combined end point of death or rehospitalization. Results: The use of PPIs was independently associated with mortality (hazard ratio, 1.51 [95{\%} CI, 1.03-2.77]) but not with the combined end point (1.49 [0.98-2.17]). An increased risk of mortality was observed among patients exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95{\%} CI, 1.22-7.16]). Conclusions and Relevance: In older patients discharged from acute care hospitals, the use of high-dose PPIs is associated with increased 1-year mortality. Randomized controlled studies including older frail patients are needed. In the meantime, physicians need to use caution and balance benefits and harms in longterm prescription of high-dose PPIs.",
author = "Marcello Maggio and Andrea Corsonello and Ceda, {Gian Paolo} and Chiara Cattabiani and Fulvio Lauretani and Valeria Butt{\`o} and Luigi Ferrucci and Stefania Bandinelli and Abbatecola, {Angela Marie} and Liana Spazzafumo and Fabrizia Lattanzio",
year = "2013",
month = "4",
day = "8",
doi = "10.1001/jamainternmed.2013.2851",
language = "English",
volume = "173",
pages = "518--523",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "7",

}

TY - JOUR

T1 - Proton pump inhibitors and risk of 1-year mortality and rehospitalization in older patients discharged from acute care hospitals

AU - Maggio, Marcello

AU - Corsonello, Andrea

AU - Ceda, Gian Paolo

AU - Cattabiani, Chiara

AU - Lauretani, Fulvio

AU - Buttò, Valeria

AU - Ferrucci, Luigi

AU - Bandinelli, Stefania

AU - Abbatecola, Angela Marie

AU - Spazzafumo, Liana

AU - Lattanzio, Fabrizia

PY - 2013/4/8

Y1 - 2013/4/8

N2 - Importance: The use of proton pump inhibitors (PPIs) has rapidly increased during the past several years. However, concern remains about risks associated with their long-term use in older populations. Objective: To investigate the relationship between the use of PPIs and the risk of death or the combined end point of death or rehospitalization in older patients discharged from acute care hospitals. Design: We investigated the relationship between PPI use and study outcomes using time-dependent Cox proportional hazards regression in patients 65 years or older discharged from acute care medical wards from April 1 to June 30, 2007. Setting: Eleven acute care medical wards. Participants: Four hundred ninety-one patients (mean [SD] age, 80.0 [5.9] years). Main Outcome Measures: Mortality and the combined end point of death or rehospitalization. Results: The use of PPIs was independently associated with mortality (hazard ratio, 1.51 [95% CI, 1.03-2.77]) but not with the combined end point (1.49 [0.98-2.17]). An increased risk of mortality was observed among patients exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95% CI, 1.22-7.16]). Conclusions and Relevance: In older patients discharged from acute care hospitals, the use of high-dose PPIs is associated with increased 1-year mortality. Randomized controlled studies including older frail patients are needed. In the meantime, physicians need to use caution and balance benefits and harms in longterm prescription of high-dose PPIs.

AB - Importance: The use of proton pump inhibitors (PPIs) has rapidly increased during the past several years. However, concern remains about risks associated with their long-term use in older populations. Objective: To investigate the relationship between the use of PPIs and the risk of death or the combined end point of death or rehospitalization in older patients discharged from acute care hospitals. Design: We investigated the relationship between PPI use and study outcomes using time-dependent Cox proportional hazards regression in patients 65 years or older discharged from acute care medical wards from April 1 to June 30, 2007. Setting: Eleven acute care medical wards. Participants: Four hundred ninety-one patients (mean [SD] age, 80.0 [5.9] years). Main Outcome Measures: Mortality and the combined end point of death or rehospitalization. Results: The use of PPIs was independently associated with mortality (hazard ratio, 1.51 [95% CI, 1.03-2.77]) but not with the combined end point (1.49 [0.98-2.17]). An increased risk of mortality was observed among patients exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95% CI, 1.22-7.16]). Conclusions and Relevance: In older patients discharged from acute care hospitals, the use of high-dose PPIs is associated with increased 1-year mortality. Randomized controlled studies including older frail patients are needed. In the meantime, physicians need to use caution and balance benefits and harms in longterm prescription of high-dose PPIs.

UR - http://www.scopus.com/inward/record.url?scp=84876018043&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876018043&partnerID=8YFLogxK

U2 - 10.1001/jamainternmed.2013.2851

DO - 10.1001/jamainternmed.2013.2851

M3 - Article

C2 - 23460307

AN - SCOPUS:84876018043

VL - 173

SP - 518

EP - 523

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 7

ER -