Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients

Authors

  • Joshua T. Swan PharmD, BCPS,

    Corresponding author
    1. Clinical Pharmacist Specialist, Department of Pharmacy, The Methodist Hospital, Houston, Texas
    • Assistant Professor of Pharmacy Practice, Texas Southern University, Houston, Texas
    Search for more papers by this author
  • Kamal C. Wagle MD,

    1. Assistant Professor of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
    Search for more papers by this author
  • Nathaniel Thompson-Moore PharmD, BCPS,

    1. Clinical Specialist I–Internal Medicine, Department of Pharmacy, The Methodist Hospital, Houston, Texas
    Search for more papers by this author
  • George E. Taffet MD

    1. Robert J. Luchi Chair in Geriatric Medicine, Professor in Medicine, Chief, Section of Geriatrics, Baylor College of Medicine, Baylor College of Medicine, Houston, Texas
    2. Department Head, Geriatrics, The Methodist Hospital, Houston, Texas
    Search for more papers by this author

Address for correspondence and reprint requests: Joshua T. Swan, PharmD, Texas Southern University, 2450 Holcombe Blvd, Suite 2–25G, Houston, TX 77021; Telephone: 713-313-1217; Fax: 713-313-1209; E-mail: swan.joshua@gmail.com

Abstract

BACKGROUND

Initiation of cholinesterase inhibitor (ChEI) therapy for delirium during hospitalization is ineffective and may be associated with increased morbidity and mortality.

OBJECTIVE

To describe the incidence of initiating ChEI therapy during hospitalization.

DESIGN

A retrospective cross-sectional study.

SETTING

A tertiary-care academic medical center.

PATIENTS

Inpatient admissions from September 2010 through March 2011 with ChEI administration.

INTERVENTION

None.

MEASUREMENTS

Incidence of ChEI exposure, initiation of ChEI therapy, initiation of antipsychotics and benzodiazepines, infection, in-hospital mortality, and hospital length of stay.

RESULTS

The incidence of adult admissions with ChEI exposure and ChEI initiation was 23.2 (95% confidence interval: 21.2–25.4) and 2 (95% confidence interval 1.5-2.8) per 1000 admissions, respectively. Of 476 admissions receiving ChEI, 9% (n = 42) initiated therapy during the hospital stay and 91% (n = 434) continued on previously started therapy. Patients initiated on ChEI therapy frequently had infection (20 of 42) and were commonly initiated on antipsychotics (14 of 42) and benzodiazepines (13 of 42). Patients were hospitalized for a median of 2 days (interquartile range, 1–4) before initiation of ChEI and were exposed to therapy for a median of 3 days (interquartile range, 2–6). Of the 41 patients discharged from the hospital, 90% (n = 37) had orders to continue the ChEI postdischarge.

CONCLUSIONS

Despite a lack of evidence to support the practice, 9% of patients who received ChEI therapy were initiated during the inpatient setting. These patients were not routinely screened for delirium and frequently received treatments associated with delirium. Journal of Hospital Medicine 2013;8:304–308. © 2013 Society of Hospital Medicine.

Ancillary