Anticholinergic burden and 1-year mortality among older patients discharged from acute care hospital

Fabrizia Lattanzio, Francesco Corica, Roberto Schepisi, Diana Amantea, Francesco Bruno, Annalisa Cozza, Graziano Onder, Stefano Volpato, Antonio Cherubini, Carmelinda Ruggiero, Marcello G Maggio, Andrea Corsonello

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Abstract

AIM: The association between anticholinergic burden and mortality is controversial. We aimed to investigate whether the anticholinergic cognitive burden (ACB) score predicts 1-year mortality in older patients discharged from acute care hospitals.

METHODS: Our series consisted of 807 hospitalized patients aged ≥65 years. Patients were followed up for 12 months after discharge. All-cause mortality was the outcome of the study. The ACB score at discharge (0, 1, ≥2) and increasing ACB score from admission to discharge (no increase, +1, +2 or more) were calculated and used as exposure variables. Cox proportional hazards models adjusted for potential confounders were used for the analysis. Interactions between the ACB score and cognitive impairment or history of falls were also investigated.

RESULTS: During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, a discharge ACB score of ≥2 (HR 1.69, 95% CI 1.09-2.65) was significantly associated with the outcome, whereas the association between increasing ACB score of +2 or more and mortality was weaker (HR 1.30, 95% CI 0.95-1.92). The interaction between the ACB score at discharge or increasing ACB score and cognitive impairment was statistically significant (P = 0.003 and P = 0.004, respectively), whereas that between the ACB score and falls was not.

CONCLUSIONS: The ACB score at discharge and, to a lesser extent, an increasing ACB score during hospital stay are associated with an increased risk of 1-year mortality in older patients discharged from hospital. Such an association is stronger among patients with cognitive impairment. Geriatr Gerontol Int 2018; 18: 705-713.

Original languageEnglish
Pages (from-to)705-713
Number of pages9
JournalGeriatrics and Gerontology International
Volume18
Issue number5
DOIs
Publication statusPublished - May 2018

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Cholinergic Antagonists
mortality
Mortality
interaction
Proportional Hazards Models
Length of Stay
Outcome Assessment (Health Care)

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Anticholinergic burden and 1-year mortality among older patients discharged from acute care hospital. / Lattanzio, Fabrizia; Corica, Francesco; Schepisi, Roberto; Amantea, Diana; Bruno, Francesco; Cozza, Annalisa; Onder, Graziano; Volpato, Stefano; Cherubini, Antonio; Ruggiero, Carmelinda; Maggio, Marcello G; Corsonello, Andrea.

In: Geriatrics and Gerontology International, Vol. 18, No. 5, 05.2018, p. 705-713.

Research output: Contribution to journalArticle

Lattanzio, Fabrizia ; Corica, Francesco ; Schepisi, Roberto ; Amantea, Diana ; Bruno, Francesco ; Cozza, Annalisa ; Onder, Graziano ; Volpato, Stefano ; Cherubini, Antonio ; Ruggiero, Carmelinda ; Maggio, Marcello G ; Corsonello, Andrea. / Anticholinergic burden and 1-year mortality among older patients discharged from acute care hospital. In: Geriatrics and Gerontology International. 2018 ; Vol. 18, No. 5. pp. 705-713.
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abstract = "AIM: The association between anticholinergic burden and mortality is controversial. We aimed to investigate whether the anticholinergic cognitive burden (ACB) score predicts 1-year mortality in older patients discharged from acute care hospitals.METHODS: Our series consisted of 807 hospitalized patients aged ≥65 years. Patients were followed up for 12 months after discharge. All-cause mortality was the outcome of the study. The ACB score at discharge (0, 1, ≥2) and increasing ACB score from admission to discharge (no increase, +1, +2 or more) were calculated and used as exposure variables. Cox proportional hazards models adjusted for potential confounders were used for the analysis. Interactions between the ACB score and cognitive impairment or history of falls were also investigated.RESULTS: During the follow-up period, 177 out of 807 participants (21.9{\%}) died. After adjusting for potential confounders, a discharge ACB score of ≥2 (HR 1.69, 95{\%} CI 1.09-2.65) was significantly associated with the outcome, whereas the association between increasing ACB score of +2 or more and mortality was weaker (HR 1.30, 95{\%} CI 0.95-1.92). The interaction between the ACB score at discharge or increasing ACB score and cognitive impairment was statistically significant (P = 0.003 and P = 0.004, respectively), whereas that between the ACB score and falls was not.CONCLUSIONS: The ACB score at discharge and, to a lesser extent, an increasing ACB score during hospital stay are associated with an increased risk of 1-year mortality in older patients discharged from hospital. Such an association is stronger among patients with cognitive impairment. Geriatr Gerontol Int 2018; 18: 705-713.",
author = "Fabrizia Lattanzio and Francesco Corica and Roberto Schepisi and Diana Amantea and Francesco Bruno and Annalisa Cozza and Graziano Onder and Stefano Volpato and Antonio Cherubini and Carmelinda Ruggiero and Maggio, {Marcello G} and Andrea Corsonello",
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T1 - Anticholinergic burden and 1-year mortality among older patients discharged from acute care hospital

AU - Lattanzio, Fabrizia

AU - Corica, Francesco

AU - Schepisi, Roberto

AU - Amantea, Diana

AU - Bruno, Francesco

AU - Cozza, Annalisa

AU - Onder, Graziano

AU - Volpato, Stefano

AU - Cherubini, Antonio

AU - Ruggiero, Carmelinda

AU - Maggio, Marcello G

AU - Corsonello, Andrea

N1 - © 2018 Japan Geriatrics Society.

PY - 2018/5

Y1 - 2018/5

N2 - AIM: The association between anticholinergic burden and mortality is controversial. We aimed to investigate whether the anticholinergic cognitive burden (ACB) score predicts 1-year mortality in older patients discharged from acute care hospitals.METHODS: Our series consisted of 807 hospitalized patients aged ≥65 years. Patients were followed up for 12 months after discharge. All-cause mortality was the outcome of the study. The ACB score at discharge (0, 1, ≥2) and increasing ACB score from admission to discharge (no increase, +1, +2 or more) were calculated and used as exposure variables. Cox proportional hazards models adjusted for potential confounders were used for the analysis. Interactions between the ACB score and cognitive impairment or history of falls were also investigated.RESULTS: During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, a discharge ACB score of ≥2 (HR 1.69, 95% CI 1.09-2.65) was significantly associated with the outcome, whereas the association between increasing ACB score of +2 or more and mortality was weaker (HR 1.30, 95% CI 0.95-1.92). The interaction between the ACB score at discharge or increasing ACB score and cognitive impairment was statistically significant (P = 0.003 and P = 0.004, respectively), whereas that between the ACB score and falls was not.CONCLUSIONS: The ACB score at discharge and, to a lesser extent, an increasing ACB score during hospital stay are associated with an increased risk of 1-year mortality in older patients discharged from hospital. Such an association is stronger among patients with cognitive impairment. Geriatr Gerontol Int 2018; 18: 705-713.

AB - AIM: The association between anticholinergic burden and mortality is controversial. We aimed to investigate whether the anticholinergic cognitive burden (ACB) score predicts 1-year mortality in older patients discharged from acute care hospitals.METHODS: Our series consisted of 807 hospitalized patients aged ≥65 years. Patients were followed up for 12 months after discharge. All-cause mortality was the outcome of the study. The ACB score at discharge (0, 1, ≥2) and increasing ACB score from admission to discharge (no increase, +1, +2 or more) were calculated and used as exposure variables. Cox proportional hazards models adjusted for potential confounders were used for the analysis. Interactions between the ACB score and cognitive impairment or history of falls were also investigated.RESULTS: During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, a discharge ACB score of ≥2 (HR 1.69, 95% CI 1.09-2.65) was significantly associated with the outcome, whereas the association between increasing ACB score of +2 or more and mortality was weaker (HR 1.30, 95% CI 0.95-1.92). The interaction between the ACB score at discharge or increasing ACB score and cognitive impairment was statistically significant (P = 0.003 and P = 0.004, respectively), whereas that between the ACB score and falls was not.CONCLUSIONS: The ACB score at discharge and, to a lesser extent, an increasing ACB score during hospital stay are associated with an increased risk of 1-year mortality in older patients discharged from hospital. Such an association is stronger among patients with cognitive impairment. Geriatr Gerontol Int 2018; 18: 705-713.

U2 - 10.1111/ggi.13234

DO - 10.1111/ggi.13234

M3 - Article

C2 - 29292589

VL - 18

SP - 705

EP - 713

JO - Geriatrics and Gerontology International

JF - Geriatrics and Gerontology International

SN - 1447-0594

IS - 5

ER -