Abstract
Anticholinergic burden (ACB) and anemia were found associated with an increased risk of death among older patients. Additionally, anticholinergic medications may contribute to the development of anemia. Therefore, we aimed at investigating the prognostic interplay of ACB and anemia among older patients discharged from hospital. Our series consisted of 783 patients enrolled in a multicenter observational study. The outcome of the study was 1 year mortality. ACB was assessed by an Anticholinergic Cognitive Burden score. Anemia was defined as hemoglobin < 13 g/dL in men and <12 g/dL in women. The association between study variables and mortality was investigated by Cox regression analysis. After adjusting for several potential confounders, ACB score = 2 or more was significantly associated with the outcome in anemic patients (HR = 1.93, 95%CI = 1.13–3.40), but not non anemic patients (HR = 1.51, 95%CI = 0.65–3.48). An additive prognostic interaction between ACB and anemia was observed (p = 0.02). Anemia may represent a relevant effect modifier in the association between ACB and mortality.
Highlights
Anticholinergic medications are commonly used among older patients, despite the fact they are known to cause relevant side effects, including cognitive impairment and delirium, functional decline, disability and falls [1,2,3,4,5]
Anticholinergic burden (ACB) score categories (0, 1, 2 or more) were observed in 118 (28.1%), 154 (36.7%), and 148 (35.2%) patients with anemia, and in 130 (35.8%), 124 (34.2%), and 109 (30.0%) patients without anemia (p = 0.06). Those with ACB score =2 or more at discharge were older and more frequently affected by heart failure, atrial fibrillation, coronary artery disease (CAD), peripheral arterial disease (PAD), chronic obstructive pulmonary disease (COPD), and cancer compared to patients with ACB = 0
basic activities of daily living (BADL) dependency, overall comorbidity and number of prescribed medications were higher among patients with ACB score = 2 or more (Table 1)
Summary
Anticholinergic medications are commonly used among older patients, despite the fact they are known to cause relevant side effects, including cognitive impairment and delirium, functional decline, disability and falls [1,2,3,4,5]. Older patients are vulnerable to adverse reactions to anticholinergic drugs due to age-related changes in pharmacokinetics and pharmacodynamics [6], deficit of cholinergic transmission [7], comorbidity, polypharmacy, use of potentially inappropriate medications, and drug interactions [8,9]. Several prognostic interactions involving anticholinergic burden were observed with risk factors relevant to the older population, including dependency in basic activities of daily living (BADL) [15], depression [16], physical [17] and cognitive impairment [18] These findings are relevant from clinical point of view because they may help to identify patients carrying high risk of mortality in relation to cumulative exposure to anticholinergic medications who are likely to benefit of anticholinergic deprescribing
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