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Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties.
Ann Fam Med. 2020 03; 18(2):148-155.AF

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.

Authors+Show Affiliations

General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom.Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom.General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom.Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland, United Kingdom. Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom.General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom.General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom.Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, Scotland, United Kingdom.Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland, United Kingdom. Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom.Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland, United Kingdom.School of Mathematics and Statistics, University of Glasgow, University Place, Glasgow, Scotland, United Kingdom.General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom frances.mair@glasgow.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32152019

Citation

Hanlon, Peter, et al. "Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties." Annals of Family Medicine, vol. 18, no. 2, 2020, pp. 148-155.
Hanlon P, Quinn TJ, Gallacher KI, et al. Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties. Ann Fam Med. 2020;18(2):148-155.
Hanlon, P., Quinn, T. J., Gallacher, K. I., Myint, P. K., Jani, B. D., Nicholl, B. I., Lowrie, R., Soiza, R. L., Neal, S. R., Lee, D., & Mair, F. S. (2020). Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties. Annals of Family Medicine, 18(2), 148-155. https://doi.org/10.1370/afm.2501
Hanlon P, et al. Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties. Ann Fam Med. 2020;18(2):148-155. PubMed PMID: 32152019.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties. AU - Hanlon,Peter, AU - Quinn,Terence J, AU - Gallacher,Katie I, AU - Myint,Phyo K, AU - Jani,Bhautesh Dinesh, AU - Nicholl,Barbara I, AU - Lowrie,Richard, AU - Soiza,Roy L, AU - Neal,Samuel R, AU - Lee,Duncan, AU - Mair,Frances S, PY - 2019/04/18/received PY - 2019/07/24/revised PY - 2019/08/16/accepted PY - 2020/3/11/entrez PY - 2020/3/11/pubmed PY - 2021/1/26/medline KW - anticholinergic burden KW - cardiovascular events KW - mortality KW - multimorbidity KW - polypharmacy SP - 148 EP - 155 JF - Annals of family medicine JO - Ann Fam Med VL - 18 IS - 2 N2 - 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. SN - 1544-1717 UR - https://www.unboundmedicine.com/medline/citation/32152019/Assessing_Risks_of_Polypharmacy_Involving_Medications_With_Anticholinergic_Properties_ L2 - http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=32152019 DB - PRIME DP - Unbound Medicine ER -