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

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Abstract

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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Acknowledgments

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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Authors and Affiliations

  1. Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Arslan Shaukat, Amir Habib & Malaz Boustani

  2. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

    Kathleen A. Lane & Changyu Shen

  3. Division of Cardiology, Indiana University School of Medicine, 1801 N. Senate Blvd., MPC II, Suite 2000, Indianapolis, IN, 46202, USA

    Saba Khan, Yaron M. Hellman & Adnan S. Malik

  4. 785 W Walnut St, Apt B, Indianapolis, IN, 46202, USA

    Arslan Shaukat

Authors
  1. Arslan Shaukat
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  2. Amir Habib
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  3. Kathleen A. Lane
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  4. Changyu Shen
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  5. Saba Khan
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  6. Yaron M. Hellman
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  7. Malaz Boustani
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  8. Adnan S. Malik
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Corresponding authors

Correspondence to Arslan Shaukat or Adnan S. Malik.

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Shaukat, A., Habib, A., Lane, K.A. et al. Anticholinergic Medications: An Additional Contributor to Cognitive Impairment in the Heart Failure Population?. Drugs Aging 31, 749–754 (2014). https://doi.org/10.1007/s40266-014-0204-2

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  • DOI: https://doi.org/10.1007/s40266-014-0204-2

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