Drugs & Aging

, Volume 31, Issue 10, pp 749–754 | Cite as

Anticholinergic Medications: An Additional Contributor to Cognitive Impairment in the Heart Failure Population?

  • Arslan ShaukatEmail author
  • Amir Habib
  • Kathleen A. Lane
  • Changyu Shen
  • Saba Khan
  • Yaron M. Hellman
  • Malaz Boustani
  • Adnan S. MalikEmail author
Original Research Article



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.


This was a cross-sectional, retrospective, single-center study.


The study was conducted in an outpatient setting.


Patients who presented to a comprehensive heart failure clinic during a 1-month period were included.


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).


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.


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.


Cognitive Impairment Congestive Heart Failure Anticholinergic Drug Systolic Heart Failure Diastolic Heart Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



I hereby affirm that everyone who contributed significantly to the study has been listed as an author.

Arslan Shaukat, Amir Habib, Kathleen A. Lane, Changyu Shen, Saba Khan, Yaron M. Hellman, Malaz Boustani, and Adnan S. Malik have no conflicts of interest to declare.

All authors contributed significantly to the study concept and design, acquisition of data, analysis and interpretation of data, and preparation of the manuscript.

There was no sponsor’s role, and no sources of funding were used to assist in the conduct of this study.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Arslan Shaukat
    • 1
    • 4
    Email author
  • Amir Habib
    • 1
  • Kathleen A. Lane
    • 2
  • Changyu Shen
    • 2
  • Saba Khan
    • 3
  • Yaron M. Hellman
    • 3
  • Malaz Boustani
    • 1
  • Adnan S. Malik
    • 3
    Email author
  1. 1.Department of Internal MedicineIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of BiostatisticsIndiana University School of MedicineIndianapolisUSA
  3. 3.Division of CardiologyIndiana University School of MedicineIndianapolisUSA
  4. 4.IndianapolisUSA

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