Anticholinergic Burden and Cognitive Impairment in Patients with Heart Failure

Abstract

Purpose Cognitive impairment (CI) in heart failure pts. may affect performance of everyday activities that impact ability to manage chronic illness. Anticholinergic drugs are a risk factor for CI. Higher anticholinergic burden (ACB) can occur with specific medications with high anticholinergic activity or an accumulation of drugs with low, medium, and high anticholinergic burden. The ACB of drugs in HF pts. may be a factor contributing to a high prevalence of CI; however, no studies have compared ACB and CI based on severity of HF. This study aims to compare CI and ACB in pts. with Class II vs. Class III/IV HF. Methods 113 adult pts. were recruited from a HF/Transplant Program. Exclusion criteria included diagnosis of dementia, LVAD or total artificial heart. Demographic data were obtained using a self-report questionnaire; clinical data were retrieved using a medical record review. Cognitive function was measured with the MOS Cognitive Function Scale. ACB was calculated using the Anticholinergic Cognitive Burden Scoring Scale. Comorbidity was measured with the Charlson Index. Polypharmacy (>=5 drugs) was determined using a medication count. Data were analyzed using mean (SD) for continuous variables f (%) for categorical variables. Significant differences between groups were examined using Chi Square and independent t-tests. Results Participants (Class II=48, Class III/IV=65) were 62% male, 50% AA, and 56 years old. There were no sig, differences between groups based on EF (p=.116), comorbidity (p=.485), evaluation for transplant (p=.235), IV inotrope therapy (p=.132), or ACB (Class II=2.47 vs Class III/IV-2.67; p=.811). There were between group differences based on age (p=.006), listed for transplant (p=.001), evaluation for MCS (p=.007), ICD (p=.002), polypharmacy ( n=105; Class II=9.5 vs 10.03, p=.034), and CI (Class II=11.06 vs Class III/IV-16.3, p=.035). Conclusion Findings support significant CI and ACB in NYHA Class II-IV pts. with greater CI in Class III/IV pts. Pts. with HF have substantial polypharmacy that may lead to high anticholinergic drug exposure which has been correlated with increased risk for CI. Future studies should target factors influencing CI in patients with greater severity of HF.