Risk of Death Associated With Use of PPIs in Three Cohorts of Institutionalized Older People in Finland

Teramura-Grönblad, Mariko; Bell, John; Pöysti, Minna M.; Strandberg, Timo; Laurila, Jouko; Tilvis, Reijo S.; Soini, Helena; Pitkälä, Kaisu H.

doi:10.1016/j.jamda.2012.03.003

Cited by 26 publications

(18 citation statements)

References 34 publications

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“…Our results together with recent findings 12,15,16 suggest that use of PPIs is associated with an excess mortality risk in older patients discharged from acute care hospitals. Such findings need to be replicated using a randomized controlled design.…”

Section: Discussionsupporting

confidence: 84%

“…Our data are consistent with recent findings showing that PPI use is independently associated with all-cause mortality in 2 cohorts of institutionalized older people 15 and in a group of patients discharged from acute care hospitals. 16 …”

Section: Commentmentioning

confidence: 99%

“…Our study may lack precision in estimating the observed associations owing to its limited power. Although an increased risk of mortality in relation to the use of PPIs has been observed in a similar number of older patients (n = 425) discharged from hospitals, 16 limited statistical power could be particularly relevant when investigating subgroups based on the type of PPI. We could only speculate about a cause- and-effect relationship between the use of PPIs and mortality, which should be addressed in a randomized clinical trial including a substantial proportion of frail older patients.…”

Section: Commentmentioning

confidence: 99%

“…In addition, we account for data on the dosage of PPIs, which has not been evaluated in previous studies. 15,16 Furthermore, we considered several specific sources of confounding, and we used time-dependent analysis and sensitivity analysis of PPIs vs a negative control drug class to increase the robustness of our observation.…”

Section: Commentmentioning

confidence: 99%

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Proton Pump Inhibitors and Risk of 1-Year Mortality and Rehospitalization in Older Patients Discharged From Acute Care Hospitals

et al. 2013

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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.

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Section: Discussionsupporting

confidence: 84%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Proton Pump Inhibitors and Risk of 1-Year Mortality and Rehospitalization in Older Patients Discharged From Acute Care Hospitals

et al. 2013

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“…The use of high doses of PPIs has been associated with increased mortality in 491 older patients discharged from acute care hospitals, even when multivariable analysis including predictors of adverse outcomes was carried out [5]. Similarly, PPI use was independently associated with all-cause mortality in 2 cohorts of older patients in long-term care hospitals, acute geriatric wards, and nursing homes [5,24]. Similar results were seen in patients discharged from acute care hospitals [25].…”

Section: Discussionmentioning

confidence: 99%

Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease

et al. 2017

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ObjectivesProton-pump inhibitors (PPIs) seem to increase the incidence of cardiovascular events in patients with coronary artery disease (CAD), mainly in those using clopidogrel. We analysed the impact of PPIs on the prognosis of patients with stable CAD.MethodsWe followed 706 patients with CAD. Primary outcome was the combination of secondary outcomes. Secondary outcomes were 1) acute ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and 2) heart failure (HF) or death.ResultsPatients on PPIs were older [62.0 (53.0–73.0) vs. 58.0 (50.0–70.0) years; p = 0.003] and had a more frequent history of stroke (4.9% vs. 1.1%; p = 0.004) than those from the non-PPI group, and presented no differences in any other clinical variable, including cardiovascular risk factors, ejection fraction, and therapy with aspirin and clopidogrel. Follow-up was 2.2±0.99 years. Seventy-eight patients met the primary outcome, 53 developed acute ischaemic events, and 33 HF or death. PPI use was an independent predictor of the primary outcome [hazard ratio (HR) = 2.281 (1.244–4.183); p = 0.008], along with hypertension, body-mass index, glomerular filtration rate, atrial fibrillation, and nitrate use. PPI use was also an independent predictor of HF/death [HR = 5.713 (1.628–20.043); p = 0.007], but not of acute ischaemic events. A propensity score showed similar results.ConclusionsIn patients with CAD, PPI use is independently associated with an increased incidence of HF and death but not with a high rate of acute ischaemic events. Further studies are needed to confirm these findings.

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Harmful Effects of Proton Pump Inhibitors: Discrepancies Between Observational Studies and Randomized Clinical Trials—Reply

Maggio

Corsonello

2013

JAMA Intern Med

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Risk of Death Associated With Use of PPIs in Three Cohorts of Institutionalized Older People in Finland

Cited by 26 publications

References 34 publications

Proton Pump Inhibitors and Risk of 1-Year Mortality and Rehospitalization in Older Patients Discharged From Acute Care Hospitals

Proton Pump Inhibitors and Risk of 1-Year Mortality and Rehospitalization in Older Patients Discharged From Acute Care Hospitals

Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease

Harmful Effects of Proton Pump Inhibitors: Discrepancies Between Observational Studies and Randomized Clinical Trials—Reply

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