Assessing risks of polypharmacy involving medications with anticholinergic properties

Hanlon, P. et al. (2020) Assessing risks of polypharmacy involving medications with anticholinergic properties. Annals of Family Medicine, 18(2), pp. 148-155. (doi: 10.1370/afm.2501) (PMID:32152019) (PMCID:PMC7062487)

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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.

Item Type:Articles
Additional Information:K.I.G. was funded by a Stroke Association HRH Princess Margaret Clinical Lectureship Award 2017/01. T.J.Q. was funded by a Joint Stroke Association and Chief Scientist Office Senior Clinical Lectureship. B.D.J. was funded by an NHS Research for Scotland (NRS) Career Research Fellowship.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Nicholl, Dr Barbara and Jani, Dr Bhautesh and Gallacher, Dr Katie and Lee, Professor Duncan and Mair, Professor Frances and Lowrie, Dr Richard and Quinn, Dr Terry and Hanlon, Dr Peter
Authors: 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., and Mair, F. S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Science and Engineering > School of Mathematics and Statistics > Statistics
Journal Name:Annals of Family Medicine
Publisher:Annals of Family Medicine
ISSN:1544-1709
ISSN (Online):1544-1717
Copyright Holders:Copyright © 2020 Annals of Family Medicine
First Published:First published in Annals of Family Medicine 18(2):148-155
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
753662Stroke Association Clinical LectureshipKatie GallacherStroke Association (STROKEAS)TSA LECT 2017/01IHW - GENERAL PRACTICE & PRIMARY CARE