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Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes.
Ann Fam Med. 2017 Nov; 15(6):561-569.AF

Abstract

PURPOSE

No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults.

METHODS

From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up. For all 3 scales, a higher score indicates greater anticholinergic burden. We used generalized estimating equations to examine the association between anticholinergic burden (ARS and ACB: grouped from 0 to ≥4; DBI-Ach: grouped as 0, 0-0.5, and 0.5-1) and adverse outcomes, and stratified individuals by age-group (aged 65-74, 75-84, and ≥85 years).

RESULTS

Compared with the ARS and DBI-Ach, the ACB showed the strongest, most consistent dose-response relationships with risks of all 4 adverse outcomes, particularly in people aged 65 to 84 years. For example, among those 65 to 74 years old, going from an ACB score of 1 to a score of 4 or greater, individuals' adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracture-specific hospitalizations; and from 3.13 to 10.01 for incident dementia.

CONCLUSIONS

Compared with the 2 other scales studied, the ACB shows good dose-response relationships between anticholinergic burden and a variety of adverse outcomes in older adults. For primary care and geriatrics clinicians, the ACB may be a helpful tool for identifying high-risk populations for interventions.

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Authors+Show Affiliations

Hsu WH
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Wen YW
Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan City, Taiwan.
Chen LK
Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan. Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Hsiao FY
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan fyshsiao@ntu.edu.tw. School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.

MeSH

AgedAged, 80 and overCholinergic AntagonistsCognitionCohort StudiesComorbidityEmergency Service, HospitalFemaleHospitalizationHumansInappropriate PrescribingMaleRisk FactorsTaiwan

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29133497

Citation

Hsu, Wen-Han, et al. "Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes." Annals of Family Medicine, vol. 15, no. 6, 2017, pp. 561-569.
Hsu WH, Wen YW, Chen LK, et al. Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes. Ann Fam Med. 2017;15(6):561-569.
Hsu, W. H., Wen, Y. W., Chen, L. K., & Hsiao, F. Y. (2017). Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes. Annals of Family Medicine, 15(6), 561-569. https://doi.org/10.1370/afm.2131
Hsu WH, et al. Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes. Ann Fam Med. 2017;15(6):561-569. PubMed PMID: 29133497.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes. AU - Hsu,Wen-Han, AU - Wen,Yu-Wen, AU - Chen,Liang-Kung, AU - Hsiao,Fei-Yuan, PY - 2016/10/17/received PY - 2017/05/16/revised PY - 2017/06/22/accepted PY - 2017/11/15/entrez PY - 2017/11/15/pubmed PY - 2018/7/17/medline KW - Anticholinergic Cognitive Burden scale (ACB) KW - Anticholinergic Risk Scale (ARS) KW - Drug Burden Index - Anticholinergic component (DBI-Ach) KW - adverse effects KW - aged KW - anticholinergic burden KW - dementia KW - emergency department visits KW - fractures KW - hospitalizations KW - older adults KW - primary care SP - 561 EP - 569 JF - Annals of family medicine JO - Ann Fam Med VL - 15 IS - 6 N2 - PURPOSE: No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults. METHODS: From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up. For all 3 scales, a higher score indicates greater anticholinergic burden. We used generalized estimating equations to examine the association between anticholinergic burden (ARS and ACB: grouped from 0 to ≥4; DBI-Ach: grouped as 0, 0-0.5, and 0.5-1) and adverse outcomes, and stratified individuals by age-group (aged 65-74, 75-84, and ≥85 years). RESULTS: Compared with the ARS and DBI-Ach, the ACB showed the strongest, most consistent dose-response relationships with risks of all 4 adverse outcomes, particularly in people aged 65 to 84 years. For example, among those 65 to 74 years old, going from an ACB score of 1 to a score of 4 or greater, individuals' adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracture-specific hospitalizations; and from 3.13 to 10.01 for incident dementia. CONCLUSIONS: Compared with the 2 other scales studied, the ACB shows good dose-response relationships between anticholinergic burden and a variety of adverse outcomes in older adults. For primary care and geriatrics clinicians, the ACB may be a helpful tool for identifying high-risk populations for interventions. SN - 1544-1717 UR - https://www.unboundmedicine.com/medline/citation/29133497/Comparative_Associations_Between_Measures_of_Anti_cholinergic_Burden_and_Adverse_Clinical_Outcomes_ DB - PRIME DP - Unbound Medicine ER -