New and persistent psychoactive medication use in intensive care unit survivors with COVID-19: a multicentre...

We sought to determine the frequency of new psychoactive medication prescriptions after hospital discharge in COVID-19 intensive care unit (ICU) survivors and describe associated 1-year clinical outcomes.

In a multicentre population-based cohort study using linked provincial health data sets from Alberta, Canada to identify comorbidities, ICU interventions, laboratory values, and medications, we included all adults admitted to an ICU with COVID-19 who survived to hospital discharge between January 2021 and July 2022. We identified new psychoactive medication recipients at discharge and persistent recipients after 1-year. An inverse probability of treatment weighting model quantified the association with 1-year all-cause mortality, hospital readmission, and emergency department (ED) visits.

We found that 1,486 psychoactive-naïve adults (mean, 56 yr; 67.5% male) survived an ICU stay with COVID-19, and 261 (17.6%) of these filled psychoactive prescriptions after hospital discharge. Common prescriptions included benzodiazepines (41%), opioids (28.3%), antipsychotics (20.3%), and selective serotonin reuptake inhibitors (15.0%). At 1 year, 135 (51.7% of new recipients) had persistent medication dispensations. Patients with new discharge prescriptions had higher 1-year all-cause mortality (10.3% vs 5.4%; adjusted odds ratio [aOR] 1.64; 95% confidence interval [CI], 1.15 to 2.55), re-hospitalization (37.6% vs 47.5%; aOR, 1.47; 95% CI, 1.20 to 1.81), and ED visits (58.2% vs 41.8%; aOR, 1.95; 95% CI, 1.59 to 2.40).

New psychoactive medication prescriptions were common (17.6%) in COVID-19 ICU survivors, among whom approximately half of patients were still receiving these medications 1 year later. The higher risk of health care utilization and mortality associated with new post-discharge psychoactive medications suggests the need for closer postdischarge follow-up and reassessment of medication appropriateness.