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

Ann-Katrin Edlund,Juraj Secnik,Edwin C.K Tan,Hong Xu,Dorota Religa,Sara Garcia-Ptacek,Maria Eriksdotter,Karin Westling,Minh Tuan Hoang,Kristina Johnell

doi:10.1016/j.jamda.2020.11.013

Abstract

ObjectivesEvidence 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. DesignObservational cohort study. Setting and ParticipantsA total of 40,219 patients with recently diagnosed dementia in memory clinics from the Swedish Dementia Registry (SveDem) from 2008 to 2017. MethodsIn 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. ResultsAfter 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. Conclusions and ImplicationsOver 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.

Highlights

ObjectivesEvidence is lacking on how treatment of comorbidities improves outcomes in patients with dementia
We evaluated the incidence of fractures, major cardiovascular events (MACE), and death within 1 year from the dementia diagnosis date using standardized incidence rates via logistic regression models to account for differences in patient characteristics over time
ChEIs were used in 77% and memantine in 14% of patients with Alzheimer's disease (AD) and mixed AD-vascular dementia (VaD) at the time of dementia diagnosis

Summary

Objectives

Evidence is lacking on how treatment of comorbidities improves outcomes in patients with dementia. We evaluated temporal changes in the management of comorbidities in relation to survival rates in incident dementia over a 10-year period in Sweden. Compared with the general population, the risk of death declined by 11%, corresponding to standardized incidence rate ratio, between 2008 and 2016. 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. Ó 2020 AMDA e The Society for Post-Acute and Long-Term Care Medicine.

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Discussion

Conclusion