| Title: | Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties |
| Journal: | The Annals of Family Medicine |
| Published: | 9 Mar 2020 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/32152019/ |
| DOI: | https://doi.org/10.1370/afm.2501 |
| URL: | https://www.annfammed.org/content/annalsfm/18/2/148.full.pdf |
| Citations: | 45 (16 in last 2 years) as of 8 Aug 2024 |
Publication 3689
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Abstract
PURPOSE: Anticholinergic burden (ACB), the cumulative effect of anticholinergic medications, is associated with adverse outcomes in older people but is less studied in middle-aged populations. Numerous scales exist to quantify ACB. The aims of this study were to quantify ACB in a large cohort using the 10 most common anticholinergic scales, to assess the association of each scale with adverse outcomes, and to assess overlap in populations identified by each scale. METHODS: We performed a longitudinal analysis of the UK Biobank community cohort (502,538 participants, baseline age: 37-73 years, median years of follow-up: 6.2). The ACB was calculated at baseline using 10 scales. Baseline data were linked to national mortality register records and hospital episode statistics. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular event (MACE). Secondary outcomes were all-cause mortality, MACE, hospital admission for fall/fracture, and hospital admission with dementia/delirium. Cox proportional hazards models (hazard ratio [HR], 95% CI) quantified associations between ACB scales and outcomes adjusted for age, sex, socioeconomic status, body mass index, smoking status, alcohol use, physical activity, and morbidity count. RESULTS: Anticholinergic medication use varied from 8% to 17.6% depending on the scale used. For the primary outcome, ACB was significantly associated with all-cause mortality/MACE for each scale. The Anticholinergic Drug Scale was most strongly associated with mortality/MACE (HR = 1.12; 95% CI, 1.11-1.14 per 1-point increase in score). The ACB was significantly associated with all secondary outcomes. The Anticholinergic Effect on Cognition scale was most strongly associated with dementia/delirium (HR = 1.45; 95% CI, 1.3-1.61 per 1-point increase). CONCLUSIONS: The ACB was associated with adverse outcomes in a middle- to older-aged population. Populations identified and effect size differed between scales. Scale choice influenced the population identified as potentially requiring reduction in ACB in clinical practice or intervention trials.16 Keywords
- Aged
- Cardiovascular Diseases
- Cause of Death
- Cholinergic Antagonists
- Cognition
- Dementia
- Female
- Hospitalization
- Humans
- Longitudinal Studies
- Male
- Middle Aged
- Polypharmacy
- Proportional Hazards Models
- Risk Assessment
- United Kingdom
11 Authors
- Peter Hanlon
- Terence J. Quinn
- Katie I. Gallacher
- Phyo K. Myint
- Bhautesh Dinesh Jani
- Barbara I. Nicholl
- Richard Lowrie
- Roy L. Soiza
- Samuel R. Neal
- Duncan Lee
- Frances S. Mair
1 Application
| Application ID | Title |
|---|---|
| 14151 | Exploring multimorbidity in UK Biobank ? patterns of illness reporting and effects of comorbidity and multimorbidity on health outcomes |
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