Does Anticholinergic Effect of Heart Failure Medications Contribute to Cognitive Dysfunction?

Abstract

<h3>Purpose</h3> Cognitive dysfunction (CD) is prevalent in patients with heart failure (HF). The purpose of this study is to determine if there is a relationship between medications with known anticholinergic burden (ACB) used as goal directed medical therapy (GDMT) in patients with HF and the presence of CD. <h3>Methods</h3> In this prospective study of CD in HF, a review of the data was performed for ACB medications and scores on the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Mean scores for the RBANS and all subscales were compared using Mann Whitney U statistics to patients receiving or not receiving known ACB medications. Spearman's Rank Correlations were used to assess the relationship between RBANS scores and ACB medications. <h3>Results</h3> 72 patients were enrolled, mean age 54.9 (30-75), 38 male. Mean level of education was 14 years. Participants received an average of 2.09 ACB medications, (furosemide in 36, hydralazine in 16, isosorbide in 16, metoprolol in 21, warfarin in 29 and digoxin in 26 participants) with 5 patients receiving none. RBANS mean score was 82.3(51-107), immediate memory (IM) 87.9 (49-120), visuospatial constructional (VSC) 73.7 (50-112), language 92.4 (54-114), attention 90.9 (43-125) and delayed memory 87.8 (44-110). Patients receiving at least 1 ACB medications had significantly lower RBANS and IM scores than those who were not. Patients receiving at least 3 ACB medications had significantly lower VSC scores than those who were not. Participants receiving furosemide had significantly lower VSC and attention scores than those who were not. Patients receiving hydralazine had significantly lower RBANS score and VSC scores than those who were not. Spearman Rank correlations demonstrated significant negative correlations between RBANS and IM scores and the use of at least 1 ACB medications; VSC scores and the use of least 3 ACB medications and furosemide or hydralazine use; attention scores and furosemide use; delayed memory scores and the use of at least 6 ACB medications and metoprolol use. There was no significant relationship between digoxin, isosorbide and warfarin use and any scores. <h3>Conclusion</h3> The use of certain medications in HF may contribute to the CD in HF. Providers who treat patients with HF should consider the ACB burden of medications used in GDMT. Further studies are needed to determine if alternative medications are correlated to CD.