The prognostic value of anticholinergic burden measures in relation to mortality in older individuals: a systematic review and meta-analysis

Graves-Morris, K., Stewart, C., Soiza, R. L., Taylor-Rowan, M. , Quinn, T. J. , Loke, Y. K. and Myint, P. K. (2020) The prognostic value of anticholinergic burden measures in relation to mortality in older individuals: a systematic review and meta-analysis. Frontiers in Pharmacology, 11, 570. (doi: 10.3389/fphar.2020.00570)

Abstract

Background: Greater anticholinergic burden (ACB) increases the risk of mortality in older individuals, yet the strength of this association varies between studies. One possible explanation for this variance is the use of different approaches to quantify ACB. This systematic review (PROSPERO number CRD42019115918) assessed the prognostic utility of ACB-specific measures on mortality in older individuals. Methods: Multiple cross-disciplinary databases were searched from 2006–2018. Observational studies assessing the association between ACB and mortality utilizing ≥1 ACB measure, involving persons aged ≥65 years were included. Screening and data extraction were performed by two independent reviewers, with disagreements resolved by a third independent reviewer. Risk of bias and quality of evidence were assessed using Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. Meta-analysis was conducted where appropriate. Results: Of 19,224 titles, 20 articles describing 18 cohort studies involving 498,056 older individuals were eligible. Eight anticholinergic-specific measures were identified; the Anticholinergic Cognitive Burden Scale (ACBS, n=9) and Anticholinergic Risk scale (ARS, n=8) were most frequently reported. The evidence base was of poor quality, with moderate to high risk of bias. Meta-analysis showed increased mortality risk. Conclusions: There was a modest association between some ACB measures and mortality, with most evidence derived from the ACBS. Studies comparing different measures within the same population were lacking. Analysis was limited by poor generalizability between studies, specifically regarding heterogeneity in methodology and reporting, as well as high risk of bias for most studies in the evidence base.

• Item Type: Articles
• Additional Information: Funding: This work was supported by The Dunhill Medical Trust (grant number RPGF1806/66) and KG-M received an Aberdeen Summer Research Scholarship funded by the Institute of Applied Health Sciences as part of Aberdeen Clinical Academic Training (ACAT) Programme.
• Keywords: Pharmacology, anticholinergics, adverse outcomes, prognostic study, older adults, measurement scales.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor-Rowan, Dr Martin and Quinn, Professor Terry

Creator Roles

Taylor-Rowan, M.: Writing – original draft, Formal analysis
Quinn, T.: Writing – original draft, Formal analysis

• Authors: Graves-Morris, K., Stewart, C., Soiza, R. L., Taylor-Rowan, M., Quinn, T. J., Loke, Y. K., and Myint, P. K.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Frontiers in Pharmacology
• Publisher: Frontiers Media S.A.
• ISSN: 1663-9812
• ISSN (Online): 1663-9812
• Copyright Holders: Copyright © 2020 Graves-Morris, Stewart, Soiza, Taylor-Rowan, Quinn, Loke and Myint
• First Published: First published in Frontiers in Pharmacology 11:570
• Publisher Policy: Reproduced under a Creative Commons Licence