Complex ICU patients at higher risk for inappropriate PPIs
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Among patients in the intensive care unit without a documented indication for proton pump inhibitor use, more than one quarter were still discharged on a PPI, according to research from Digestive Disease Week.
In a recorded audio presentation of the data, John W. Blackett, MD, a second-year gastroenterology fellow at Columbia University, said that while PPIs are safe when used appropriately, they are among the most overused medications.
“Prior studies have suggested that 60% to 80% of PPIs started in the hospital lack an appropriate, long-term indication,” he said. “Despite earlier concerns about long-term, adverse consequences of PPI use, the overall safety profile of PPIs is probably favorable. Still, it’s wasteful to continue them in the outpatient setting unless they have some reasonable probability of benefit.”
Researchers performed a retrospective cohort study from 2014 to 2018 comprising adult patients who started PPI therapy in the ICU and survived to discharge. They excluded patients if they were on a PPI prior to ICU admission or had an appropriate indication for continuing PPI. They identified characteristics that were associated with discharge on an inappropriate PPI after hospitalization compared with patients who discontinued PPIs.
Of 22,389 total patients, 4,127 initiated a new PPI. Investigators classified 2,467 of those patients as inappropriate because they lacked documentation of one of the indications for the drug (60%). Among those patients, 1,121 continued on a PPI after transfer to the floor (45%) and 668 were discharged on a PPI (27%).
After adjusting for age, sex and other factors, researchers determined that having an upper endoscopy without findings (OR = 1.66; 95% CI, 1.06-2.62), admission to the surgical compared with the medical ICU (OR = 2.17; 95% CI, 1.42-3.33) and discharge to a nursing (OR = 1.49; 95% CI, 1.06-2.08) or rehabilitation (OR = 2.39; 95% CI 1.69-3.39) facility compared with home were all risk factors for PPI prescription.
“Future directions for this project would potentially be an intervention to reduce the prescription of unnecessary PPIs after transfer from the ICU,” Blackett said. “This could potentially take the form of an electronic medical record alert that prompts to consider whether acid suppression is still a concern at the time of transfer to the floor or an educational initiative aimed at the ICU where this issue was found to be most prevalent.
Reference:
Salem J, et al. Abstract 520. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).
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