Hospital patients given anti-heartburn drugs have higher risk of dying

http://www.eurekalert.org/pub_releases/2015-11/uomh-fdn110615.php

Public Release: 10-Nov-2015
First, do no harm: Hospital patients given anti-heartburn drugs have higher risk of dying
U-M/VA computer model suggests that common use of acid-reducing medicine to prevent stomach bleeding increases mortality from infections
University of Michigan Health System

Right now, in any American hospital, about half of the patients have a prescription for an acid-reducing drug to reduce heartburn or prevent bleeding in their stomach and gut.

But that well-intentioned drug may actually boost their risk of dying during their hospital stay, a new study finds - by opening them up to infections that pose more risk than bleeding would.

In fact, according to a computer simulation based on real-world risk and benefit data, around 90 percent of hospital inpatients who were first prescribed these drugs in the hospital have a higher risk of dying when they're taking them, compared with their risk if they hadn't gotten the prescription.

And for around 80 percent of patients who were already on these common drugs, called proton-pump inhibitors or PPIs, when they arrived at the hospital, staying on them also may lead to a small increase in the risk of dying.

The extra risk of death comes from the fact that reducing acid in the stomach can increase the risk of infections - especially pneumonia and Clostridium difficile, both of which pose a serious risk to hospitalized patients who develop them.

The study, which uses a computer model to achieve a result that otherwise would require an impractically large clinical trial, is published in the Journal of General Internal Medicine by a team from the University of Michigan Medical School and VA Ann Arbor Healthcare System.

"Many patients who come into the hospital are on these medications, and we sometimes start them in the hospital to try to prevent gastrointestinal, or GI, bleeds," says lead author Matthew Pappas, M.D., MPH.

"But other researchers have shown that these drugs seem to increase the risk of pneumonia and C. diff, two serious and potentially life-threatening infections that hospitalized patients are also at risk for," he continues. "Our new model allows us to compare that increased risk with the risk of upper GI bleeding. In general, it shows us that we're exposing many inpatients to higher risk of death than they would otherwise have - and though it's not a big effect, it is a consistent effect."

As a result of the new findings, he says, very few hospital patients should start taking or continue on PPIs as a preventive measure against gastrointestinal bleeding.

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