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Association of Anticholinergic Drugs with Hospitalization and Mortality among Older Cardiovascular Patients

A Prospective Study

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Abstract

Background: Many potentially inappropriate drugs prescribed to older people have anticholinergic properties as adverse effects and are therefore potentially harmful. These effects typically include constipation, dry mouth, blurred vision, dizziness and slowing of urination. It has been shown that drugs with anticholinergic properties (DAPs) are associated with cognitive decline and dementia, may contribute to events such as falls, delirium and impulsive behaviour, are associated with self-reported adverse effects and physical impairment, and may even be associated with mortality. However, studies of the prognostic implications of DAPs remain scarce.

Objective: To evaluate the impact of DAPs on hospitalization and mortality in older patients with stable cardiovascular disease (CVD).

Methods: This was a prospective study with a mean follow-up of 3.3 years involving two study groups: users (n = 295) and non-users (n = 105) of DAPs. The participants were 400 community-dwelling older people (aged 75–90 years) with stable CVD participating in a secondary prevention study of CVD (DEBATE) in Helsinki, Finland. The use of DAPs was estimated using definitions from the previous scientific literature. The Charlson Comorbidity Index (CCI) was used to estimate the burden of co-morbidity and the Mini-Mental State Examination test was used to assess cognitive function. The risks in the two study groups for hospital visits, number of days spent in hospital care and mortality were measured from 2000 to the end of 2003.

Results: The unadjusted follow-up mortality was 20.7% and 9.5% among the users and non-users of DAPs, respectively (p = 0.010). However, the use of DAPs was not a significant predictor of mortality in multivariate analysis after adjustment for age, sex and CCI score (hazard ratio 1.57; 95% CI 0.78, 3.15). The mean ± SD number of hospital days per person-year was higher in the DAP user group (14.9± 32.5) than in the non-user group (5.2± 12.3) [p < 0.001]. In a bootstrap-type analysis of covariance adjusted for age, sex and CCI score, the use of DAPs predicted the number of days spent in hospital (p = 0.011).

Conclusions: The use of DAPs in older patients with stable CVD was associated with an increased number of hospital days but not with mortality.

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Acknowledgements

The DEBATE study was supported by the Academy of Finland (grant 48613), the Lions Organization (Punainen Sulka-Red Feather), the Ragnar Ekberg Foundation, the Finnish Foundation for Cardiovascular Research, and the Helsinki University Central Hospital. None of these organizations played any role in the conduct of the study or the preparation of this article.

The contributions of the authors to the study and preparation of the article were as follows: conception and design by JU, KHP, RST, TES; acquisition, analysis and interpretation of data by JU, KHP, HK and TES; drafting of the article or critical revision for intellectual content by JU, KHP, HK, RST and TES; final approval of the submitted version by JU, KHP, HK, RST and TES. TES is the guarantor.

The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Unit of General Practice, Helsinki University Hospital, Helsinki, Finland

    Juho Uusvaara & Kaisu H. Pitkala

  2. Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland

    Kaisu H. Pitkala

  3. ORTON Orthopaedic Hospital, Orton Foundation, Helsinki, and Unit of Family Practice, Central Hospital of Central Finland, Jyväskylä, Finland

    Hannu Kautiainen

  4. Unit of General Internal Medicine and Geriatrics, Helsinki University Hospital, Helsinki, Finland

    Reijo S. Tilvis

  5. Department of Health Sciences/Geriatrics and Oulu University Hospital, Unit of General Practice, University of Oulu, Oulu, Finland

    Timo E. Strandberg

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  1. Juho Uusvaara
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Correspondence to Juho Uusvaara.

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Uusvaara, J., Pitkala, K.H., Kautiainen, H. et al. Association of Anticholinergic Drugs with Hospitalization and Mortality among Older Cardiovascular Patients. Drugs Aging 28, 131–138 (2011). https://doi.org/10.2165/11585060-000000000-00000

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