Anticholinergic Medication Burden and 5-Year Risk of Hospitalization and Death in Nursing Home Elderly Residents With Coronary Artery Disease

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• 作者：Davide L. Vetrano ; MD^a ; ^b ; ^{davide.vetrano@ki.se" class="auth_mail" title="E-mail the corresponding author} ; ^{davidevetrano@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Domenico La Carpia ; MD^b ; Giulia Grande ; MD^a ; ^c ; Paola Casucci ; MSc^d ; Tiziana Bacelli ; MSc^d ; Roberto Bernabei ; MD^b ; Graziano Onder ; MD ; PhD^b ; on behalf of the Italian Group for Appropriate Drug Prescription in the Elderly (I-GrADE)Nera Agabiti ; Claudia Bartolini ; Roberto Bernabei ; Alessandra Bettiol ; Stefano Bonassi ; Achille Patrizio Caputi ; Silvia Cascini ; Alessandro Chinellato ; Francesco Cipriani ; Giovanni Corrao ; Marina Davoli ; Massimo Fini ; Rosa Gini ; Francesco Giorgianni ; Ursula Kirchmayer ; Francesco Lapi ; Niccolò ; Lombardi ; Ersilia Lucenteforte ; Alessandro Mugelli ; Graziano Onder ; Federico Rea ; Giuseppe Roberto ; Chiara Sorge ; Michele Tari ; Gianluca Trifirò ; Alfredo Vannacci ; Davide Liborio Vetrano ; Cristiana Vitale
• 关键词：Anticholinergics ; nursing home ; ischemic heart disease ; hospitalization ; mortality
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：17
• 期：11
• 页码：1056-1059
• 全文大小：331 K

文摘

To assess the association of the anticholinergic medication burden with hospitalization and mortality in nursing home elderly patients and to investigate the role of coronary artery disease (CAD).

Design

Longitudinal (5-year) retrospective observational study.

Setting

Nursing homes in Italy.

Participants

A total of 3761 nursing home older residents.

Measurements

A comprehensive clinical and functional assessment was carried out through the interRAI long-term care facility instrument. The anticholinergic burden was assessed through the anticholinergic cognitive burden (ACB) scale. Occurrence of hospitalization/all-cause mortality was the primary composite outcome. First hospitalization and all-cause mortality were the secondary outcomes of the study. Hazard ratios (HRs) and subdistribution HRs were obtained through Cox and competing risk (death as competing event for hospitalization) models.

Results

Within the sample (mean age 83 ± 7 years; 72% females) the incidence rate of the primary outcome was 10/100 person-year. After adjusting for potential confounders and compared with participants with an ACB of 0, those with an ACB of 1 [HR 1.46; 95% confidence interval (CI) 1.12–1.90] and ABC of 2+ (HR 1.41; 95% CI 1.11–1.79) presented an increased risk of developing the primary outcome. After stratification, the risk for the primary outcome increased along with the anticholinergic burden, only for participants affected by CAD (HR 1.53; 95% CI 0.94–2.50 and HR 1.71; 95% CI 1.09–2.68 for the ACB of 1 and ACB of 2+ groups). An ACB score of 2+ was marginally associated with first hospitalization, considering death as a competing risk, only for those with CAD (subdistribution HR 3.47; 95% CI 0.99–12.3).

Conclusions

Anticholinergic medication burden is associated to hospitalization and all-cause mortality in institutionalized older adults. CAD increases such risk. The effectiveness and safety profile of complex drug regimens should be reconsidered in this population.