Joana Rigor1, Inês Rueff Rato2, Paula Marques Ferreira2, Rita Pereira2, Catarina Ribeiro3, Diogo Teixeira4, Pedro Mesquita Oliveira5, Ana Mafalda Silva6, Sofia Pereira2, Ingride Costa2, Paula Ferreira2, Manuela Sequeira2, Matilde Monteiro-Soares7, Daniela Martins-Mendes8. 1. Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal. Electronic address: rigorj.md@gmail.com. 2. Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal. 3. Nephrology Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal. 4. Dermatology Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal. 5. Intensive Care Unit, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal. 6. Internal Medicine Department, Entre Douro e Vouga Hospital Center, E.P.E., Santa Maria da Feira, Portugal. 7. MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Porto, Portugal. 8. Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal; Biomedicine Department, Faculty of Medicine of the University of Porto, Porto, Portugal; i3S-Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal.
Abstract
OBJECTIVES: Anticholinergic drugs have several side effects, and they have been associated with adverse outcomes, particularly in older patients. The aim of this study was to analyze anticholinergic burden and its relationship to delirium and mortality in older acutely ill medical patients. DESIGN: Cohort study. SETTING AND PARTICIPANTS: Patients 65 years of age and older who were admitted to an Internal Medicine ward between August 1 and December 31, 2016. METHODS: Anticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion Assessment Method (Short-CAM). RESULTS: Of the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51]. Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug use, ACB, or delirium. DISCUSSION: In the population studied, we found an association between anticholinergic burden as measured by the ACB and the presence of delirium, but not with mortality at 12 months. A very high 12-month mortality rate might have been an obstacle for association recognition. CONCLUSIONS AND IMPLICATIONS: Clinician awareness of possible drug side effects, especially in older populations, is crucial. As part of medication reconciliation at the time of hospitalization, ACB of prehospitalization medications should be routinely calculated by inpatient pharmacy services and made available to medical teams.
OBJECTIVES: Anticholinergic drugs have several side effects, and they have been associated with adverse outcomes, particularly in older patients. The aim of this study was to analyze anticholinergic burden and its relationship to delirium and mortality in older acutely ill medical patients. DESIGN: Cohort study. SETTING AND PARTICIPANTS: Patients 65 years of age and older who were admitted to an Internal Medicine ward between August 1 and December 31, 2016. METHODS: Anticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion Assessment Method (Short-CAM). RESULTS: Of the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51]. Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug use, ACB, or delirium. DISCUSSION: In the population studied, we found an association between anticholinergic burden as measured by the ACB and the presence of delirium, but not with mortality at 12 months. A very high 12-month mortality rate might have been an obstacle for association recognition. CONCLUSIONS AND IMPLICATIONS: Clinician awareness of possible drug side effects, especially in older populations, is crucial. As part of medication reconciliation at the time of hospitalization, ACB of prehospitalization medications should be routinely calculated by inpatient pharmacy services and made available to medical teams.
Authors: Nirit Tzur Efraim; Evgeniya Zikrin; David Shacham; Dori Katz; Evgeni Makulin; Leonid Barski; Lior Zeller; Carmi Bartal; Tamar Freud; Svetlana Lebedinski; Yan Press Journal: Front Med (Lausanne) Date: 2020-10-19