Anticholinergic medications: an additional contributor to cognitive impairment in the heart failure population?
Arslan Shaukat1, Amir Habib, Kathleen A Lane
1Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA, arslan.shaukat@gmail.com.
Insights
Congestive heart failure patients often take anticholinergic drugs, increasing cognitive impairment risk. This study found a significant medication cognitive burden in these patients, potentially worsening their condition.
Area of Science:
- Geriatric Medicine
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) is linked to cognitive impairment, with multifactorial causes.
- Anticholinergic drug burden is a known risk factor for cognitive decline in the elderly.
Purpose of the Study:
- To assess the cognitive burden of medications in patients with CHF.
- To evaluate the anticholinergic cognitive burden (ACB) and ACB in CHF (ACB-CHF) scores.
Main Methods:
- Cross-sectional, retrospective, single-center study in an outpatient setting.
- Included 182 patients from a comprehensive heart failure clinic.
- Calculated ACB and ACB-CHF scores using the ACB Scoring Scale (ACB-SS).
Main Results:
- Mean ACB score was 2.4, and mean ACB-CHF score was 1.0.
- 25.8% of patients had a high anticholinergic burden (ACB-CHF score of 2 or 3).
- No association found between ejection fraction and ACB or ACB-CHF scores.
Conclusions:
- Patients with CHF experience substantial exposure to anticholinergic medications.
- This medication burden may contribute to cognitive impairment in CHF patients.
- Highlights a potential target for improving cognitive function in heart failure.
Background/Objectives:
Patients with congestive heart failure (CHF) have a high prevalence of cognitive impairment and the association is multifactorial. In general, the burden of anticholinergic drugs has consistently been shown to be a risk factor for cognitive impairment in the elderly. The aim of this study was to assess the cognitive burden of medications in patients with CHF.
Design:
This was a cross-sectional, retrospective, single-center study.
Setting:
The study was conducted in an outpatient setting.
Participants:
Patients who presented to a comprehensive heart failure clinic during a 1-month period were included.
Measurements:
The primary outcomes of interest were mean anticholinergic cognitive burden (ACB) score of all medications and CHF medications (ACB-CHF), calculated based on the ACB Scoring Scale (ACB-SS). The ACB-CHF score was further dichotomized as 0 or 1 (low anticholinergic burden) versus 2 or 3 (high anticholinergic burden).
Results:
A total of 182 patients were included. The mean ACB and ACB-CHF scores were 2.4 (range 0-13) and 1.0 (range 0-4), respectively, while 25.8 % of patients had an ACB-CHF score of 2 or 3. There was no association found between ejection fraction in patients with systolic heart failure and the ACB (p = 0.28) or ACB-CHF (p = 0.62) score.
Conclusion:
We conclude that patients with CHF have a substantial exposure to anticholinergic medications with adverse cognitive effects. This may be another important contributor to the increased prevalence of cognitive impairment in these patients.
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