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Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study.
Int J Environ Res Public Health. 2020 05 26; 17(11)IJ

Abstract

AIM

Older patients with chronic hepatitis C infection starting direct-acting antivirals (DAAs) are frequently prescribed multiple medications that may be categorized as inappropriate. Anticholinergic burden has been shown to be a predictor of adverse health and functional outcomes. Different scales are available to calculate anticholinergic burden. The aim of this study was to determine the prevalence of anticholinergic medication among older patients treated with DAAs and the risk factors associated using the Anticholinergic Cognitive Burden (ACB) scale, the Anticholinergic Risk Scale (ARS) and the Anticholinergic Drug Scale (ADS) and analyze the resulting safety consequences.

METHODS

Observational, retrospective cohort study of consecutive patients ≥65 years old receiving DAAs and taking concomitant medication. This study was conducted in accordance with the Strengthening the Reporting of observational studies in Epidemiology Statement.

RESULTS

236 patients were included. The average age was 71.7 years, 73.3% cirrhotic, and 47% patients took ≥5 medicines. According to the ACB, ARS and ADS scales, 35.2% (n = 83), 10.6% (n = 25) and 34.3% (n = 81) of the patients were treated with anticholinergic medication. Two hundred-and-six (86%) patients presented any adverse events (AEs) during therapy. ARS scale showed a significant relationship between presence of anticholinergic medication and AEs. A large number of patients suffered anticholinergic events, with more events per patient in patients taking anticholinergic drugs.

CONCLUSIONS

Older hepatitis C chronic patients are exposed to potentially inappropriate polypharmacy and anticholinergic risk, according to the ACB, ARS and ADS scales. The three scales showed different results. Only the ARS scale was associated with AEs, but the rate of anticholinergic effects per patient was significantly higher in patients with anticholinergic drugs, regardless of the scale used. Consider quality of pharmacotherapy when starting DAA with a multidisciplinary approach could improve health outcomes.

Authors+Show Affiliations

Pharmacy Service Hospital Clínic de Barcelona, 08036 Barcelona, Spain.Pharmacy Service Division of Medicines Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, 08036 Barcelona, Spain.School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain.Liver Unit Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, 08036 Barcelona, Spain. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain.

Pub Type(s)

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

Language

eng

PubMed ID

32466526

Citation

Amoros-Reboredo, Patricia, et al. "Anticholinergic Burden and Safety Outcomes in Older Patients With Chronic Hepatitis C: a Retrospective Cohort Study." International Journal of Environmental Research and Public Health, vol. 17, no. 11, 2020.
Amoros-Reboredo P, Soy D, Hernandez-Hernandez M, et al. Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study. Int J Environ Res Public Health. 2020;17(11).
Amoros-Reboredo, P., Soy, D., Hernandez-Hernandez, M., Lens, S., & Mestres, C. (2020). Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study. International Journal of Environmental Research and Public Health, 17(11). https://doi.org/10.3390/ijerph17113776
Amoros-Reboredo P, et al. Anticholinergic Burden and Safety Outcomes in Older Patients With Chronic Hepatitis C: a Retrospective Cohort Study. Int J Environ Res Public Health. 2020 05 26;17(11) PubMed PMID: 32466526.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study. AU - Amoros-Reboredo,Patricia, AU - Soy,Dolors, AU - Hernandez-Hernandez,Marta, AU - Lens,Sabela, AU - Mestres,Conxita, Y1 - 2020/05/26/ PY - 2020/03/29/received PY - 2020/05/15/revised PY - 2020/05/21/accepted PY - 2020/5/30/entrez PY - 2020/5/30/pubmed PY - 2020/10/21/medline KW - adverse events KW - ageing KW - drug use KW - patient safety KW - polypharmacy JF - International journal of environmental research and public health JO - Int J Environ Res Public Health VL - 17 IS - 11 N2 - AIM: Older patients with chronic hepatitis C infection starting direct-acting antivirals (DAAs) are frequently prescribed multiple medications that may be categorized as inappropriate. Anticholinergic burden has been shown to be a predictor of adverse health and functional outcomes. Different scales are available to calculate anticholinergic burden. The aim of this study was to determine the prevalence of anticholinergic medication among older patients treated with DAAs and the risk factors associated using the Anticholinergic Cognitive Burden (ACB) scale, the Anticholinergic Risk Scale (ARS) and the Anticholinergic Drug Scale (ADS) and analyze the resulting safety consequences. METHODS: Observational, retrospective cohort study of consecutive patients ≥65 years old receiving DAAs and taking concomitant medication. This study was conducted in accordance with the Strengthening the Reporting of observational studies in Epidemiology Statement. RESULTS: 236 patients were included. The average age was 71.7 years, 73.3% cirrhotic, and 47% patients took ≥5 medicines. According to the ACB, ARS and ADS scales, 35.2% (n = 83), 10.6% (n = 25) and 34.3% (n = 81) of the patients were treated with anticholinergic medication. Two hundred-and-six (86%) patients presented any adverse events (AEs) during therapy. ARS scale showed a significant relationship between presence of anticholinergic medication and AEs. A large number of patients suffered anticholinergic events, with more events per patient in patients taking anticholinergic drugs. CONCLUSIONS: Older hepatitis C chronic patients are exposed to potentially inappropriate polypharmacy and anticholinergic risk, according to the ACB, ARS and ADS scales. The three scales showed different results. Only the ARS scale was associated with AEs, but the rate of anticholinergic effects per patient was significantly higher in patients with anticholinergic drugs, regardless of the scale used. Consider quality of pharmacotherapy when starting DAA with a multidisciplinary approach could improve health outcomes. SN - 1660-4601 UR - https://www.unboundmedicine.com/medline/citation/32466526/Anticholinergic_Burden_and_Safety_Outcomes_in_Older_Patients_with_Chronic_Hepatitis_C:_A_Retrospective_Cohort_Study_ L2 - https://www.mdpi.com/resolver?pii=ijerph17113776 DB - PRIME DP - Unbound Medicine ER -