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Changes in Drug Prescribing Practices Are Associated With Improved Outcomes in Patients With Dementia in Sweden: Experience from the Swedish Dementia Registry 2008-2017.

Authors :
Xu H
Garcia-Ptacek S
Secnik J
Edlund AK
Westling K
Hoang MT
Johnell K
Tan ECK
Religa D
Eriksdotter M
Source :
Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2021 Jul; Vol. 22 (7), pp. 1477-1483.e3. Date of Electronic Publication: 2020 Dec 10.
Publication Year :
2021

Abstract

Objectives: Evidence is lacking on how treatment of comorbidities improves outcomes in patients with dementia. In this study, we evaluated temporal changes in the management of comorbidities in relation to survival rates in incident dementia over a 10-year period in Sweden.<br />Design: Observational cohort study.<br />Setting and Participants: A total of 40,219 patients with recently diagnosed dementia in memory clinics from the Swedish Dementia Registry (SveDem) from 2008 to 2017.<br />Methods: In 1-year blocks, pharmacological treatment of dementia and comorbidities in relationship to risk for fractures, major cardiovascular events (MACE), and death were analyzed using Cox models. Standardized Incidence Ratios (SIR) of death are presented.<br />Results: After standardization for demographics and comorbidities, the risk of fracture, MACE, and mortality decreased by 16%, 23%, and 28%, respectively, between 2008 and 2016. Each year decreased the risk of fracture by 3% (hazard ratio 0.97, 95% confidence interval 0.96-0.99), MACE by 4% (0.96, 0.95-0.97), and death by 5% (0.95, 0.93-0.97). Adjustment for changes in medication use attenuated these associations. Compared with the general population, the risk of death declined by 11%, corresponding to standardized incidence rate ratio, between 2008 and 2016.<br />Conclusions and Implications: Over 10 years, a reduction in the short-term risks of fracture, MACE, and death in patients with dementia was associated with changes in drug prescribing practices. These improvements seem to be partly explained by progressive implementation of dementia diagnostic, treatment guidelines, and general management of comorbidities.<br /> (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1538-9375
Volume :
22
Issue :
7
Database :
MEDLINE
Journal :
Journal of the American Medical Directors Association
Publication Type :
Academic Journal
Accession number :
33309648
Full Text :
https://doi.org/10.1016/j.jamda.2020.11.013