Helsinki University Hospital, Finland.
Drugs Aging. 2011 Feb 1;28(2):131-8. doi: 10.2165/11585060-000000000-00000.
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.
To evaluate the impact of DAPs on hospitalization and mortality in older patients with stable cardiovascular disease (CVD).
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.
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).
The use of DAPs in older patients with stable CVD was associated with an increased number of hospital days but not with mortality.
许多老年人服用的潜在不适当药物具有抗胆碱能特性，作为不良反应，因此具有潜在的危害性。这些影响通常包括便秘、口干、视力模糊、头晕和排尿缓慢。已表明具有抗胆碱能特性的药物（DAPs）与认知能力下降和痴呆有关，可能导致跌倒、谵妄和冲动行为等事件，与自我报告的不良反应和身体损伤有关，甚至可能与死亡率有关。然而，关于 DAPs 的预后意义的研究仍然很少。
评估在患有稳定心血管疾病（CVD）的老年患者中，DAPs 对住院和死亡的影响。
这是一项前瞻性研究，平均随访 3.3 年，涉及两个研究组：DAPs 的使用者（n=295）和非使用者（n=105）。该研究纳入了芬兰赫尔辛基 CVD 二级预防研究（DEBATE）中 400 名居住在社区的年龄在 75-90 岁之间、患有稳定 CVD 的老年人。使用 DAPs 的情况是根据先前科学文献中的定义来估计的。Charlson 合并症指数（CCI）用于估计合并症的负担，而 Mini-Mental State Examination 测试用于评估认知功能。从 2000 年到 2003 年底，测量了两组因住院就诊、住院天数和死亡率的风险。
未调整的随访死亡率分别为 DAPs 使用者和非使用者的 20.7%和 9.5%（p=0.010）。然而，在调整年龄、性别和 CCI 评分后，DAPs 的使用在多变量分析中并不是死亡率的显著预测因素（危险比 1.57；95%CI 0.78，3.15）。DAPs 使用者的人均每年住院天数（14.9±32.5）高于非使用者（5.2±12.3）[p<0.001]。在调整年龄、性别和 CCI 评分后的 bootstrap 型协方差分析中，DAPs 的使用预测了住院天数（p=0.011）。
在患有稳定 CVD 的老年患者中使用 DAPs 与住院天数增加有关，但与死亡率无关。
