Baseline Anticholinergic Medication Burden in Patients with Overactive Bladder

The objective of this study is to quantify baseline Anticholinergic Cognitive Burden (ACB) scores among women presenting to a urogynecology practice with overactive bladder (OAB) symptoms and to examine patient characteristics associated with higher baseline ACB scores.

This retrospective study included women 18 years of age and older presenting as a new patient for evaluation of OAB at an academic urogynecology practice in 2022. A total of 242 patients met the inclusion criteria. Patient baseline characteristics, including medications, were abstracted from the electronic medical record. ACB scores were assessed using a validated four-point scale. OAB treatment after the initial visit was also abstracted.

The median ACB score was 1, with 37% of patients having a high-risk ACB score (≥3). Anticholinergics were prescribed to 3% of patients, with 71% of these having high-risk baseline ACB scores. Beta-3 agonists were prescribed to 15%, with 46% of these having high-risk baseline scores. Forty-three percent of patients prescribed beta-3 agonists did not initiate therapy owing to cost. High-risk ACB scores were associated with comorbidities such as hypertension, diabetes, anxiety, and depression. Patients with high-risk ACB scores were more likely to receive sacral neuromodulation.

Many women with OAB have high-risk baseline ACB scores. Although anticholinergics remain commonly prescribed, their cognitive risks necessitate careful patient assessment. Increasing use of safer alternatives such as beta-3 agonists and addressing cost barriers can improve OAB management. Future research should focus on reducing anticholinergic use and addressing inequity in treatment access.