Abstract：
The cumulative effect of drugs with anticholinergic properties may pose a significant risk in the post-discharge period of patients who have undergone elective cardiac surgery. The aim of this study was to investigate the association between anticholinergic burden and 6-month postdischarge mortality in older cardiac surgery patients.
This study performed a retrospective longitudinal analysis of patients undergoing elective cardiac surgery at a tertiary care centre from January 2021 to January 2022. The Deyo-Charlson comorbidity index (D-CCI) was used to estimate the burden of comorbidities. The anticholinergic burden was assessed using the Anticholinergic Cognitive Burden scale (ACB) and Drug Burden Index (DBI) scale. All-cause postdischarge mortality was determined from electronic medical records.
A total of 255 older adults who had undergone elective cardiac surgery and had been followed up for at least 6 months were included in this study. Approximately 12.5% (n = 32) of older patients died within 6 months of discharge. In multivariate Cox regression analysis, ACB (HR:1.31, 95%CI:1.10-1.56 p = 0.01) and DBI (HR:2.08, 95%CI:1.27-3.39 p = 0.01) showed significantly increased risk of 6-month postdischarge mortality after adjusting for several possible confounders (age, gender, D-CCl, and American Society of Anaesthesiologists (ASA) score). Overall event-free survival differed significantly between patients undergoing cardiac surgery based on anticholinergic burden according to the group-stratified ACB and DBI scales (χ2: 5.907, log-rank test, p = 0.015 and χ2: 15.389, log-rank test, p < 0.001 respectively).
The anticholinergic burden is associated with 6-month all-cause post-discharge mortality in older cardiac surgery patients. A deprescribing approach should be considered, especially for older adults in the perioperative period.
The trial was retrospectively registered at ClinicalTrials.gov. Identifier: NCT05312684 Registered on 5 April 2022.
This study performed a retrospective longitudinal analysis of patients undergoing elective cardiac surgery at a tertiary care centre from January 2021 to January 2022. The Deyo-Charlson comorbidity index (D-CCI) was used to estimate the burden of comorbidities. The anticholinergic burden was assessed using the Anticholinergic Cognitive Burden scale (ACB) and Drug Burden Index (DBI) scale. All-cause postdischarge mortality was determined from electronic medical records.
A total of 255 older adults who had undergone elective cardiac surgery and had been followed up for at least 6 months were included in this study. Approximately 12.5% (n = 32) of older patients died within 6 months of discharge. In multivariate Cox regression analysis, ACB (HR:1.31, 95%CI:1.10-1.56 p = 0.01) and DBI (HR:2.08, 95%CI:1.27-3.39 p = 0.01) showed significantly increased risk of 6-month postdischarge mortality after adjusting for several possible confounders (age, gender, D-CCl, and American Society of Anaesthesiologists (ASA) score). Overall event-free survival differed significantly between patients undergoing cardiac surgery based on anticholinergic burden according to the group-stratified ACB and DBI scales (χ2: 5.907, log-rank test, p = 0.015 and χ2: 15.389, log-rank test, p < 0.001 respectively).
The anticholinergic burden is associated with 6-month all-cause post-discharge mortality in older cardiac surgery patients. A deprescribing approach should be considered, especially for older adults in the perioperative period.
The trial was retrospectively registered at ClinicalTrials.gov. Identifier: NCT05312684 Registered on 5 April 2022.
摘要：
■具有抗胆碱能特性的药物的累积作用可能在接受选择性心脏手术的患者的出院后期间构成重大风险。这项研究的目的是调查老年心脏手术患者抗胆碱能负荷与出院后6个月死亡率之间的关系。
■这项研究对2021年1月至2022年1月在三级护理中心接受择期心脏手术的患者进行了回顾性纵向分析。Deyo-Charlson合并症指数（D-CCI）用于估计合并症的负担。使用抗胆碱能认知负担量表（ACB）和药物负担指数（DBI）量表评估抗胆碱能负担。根据电子病历确定全因出院后死亡率。
■本研究纳入了255名接受了选择性心脏手术并随访至少6个月的老年人。大约12.5％（n=32）的老年患者在出院后6个月内死亡。在多元Cox回归分析中，ACB（HR：1.31，95CI：1.10-1.56p=0.01）和DBI（HR：2.08，95CI：1.27-3.39p=0.01）在校正了几种可能的混杂因素后，显示出出院后6个月死亡率的风险显着增加（年龄，性别,D-CCl,和美国麻醉医师协会（ASA）评分）。根据分组分层ACB和DBI量表的抗胆碱能负荷，接受心脏手术的患者之间的总无事件生存率存在显着差异（χ2：5.907，对数秩检验，p=0.015和χ2：15.389，对数秩检验，p分别<0.001)。
■抗胆碱能负荷与老年心脏手术患者6个月全因出院后死亡率相关。应该考虑一种无效的方法，尤其是围手术期的老年人。
■这项研究对2021年1月至2022年1月在三级护理中心接受择期心脏手术的患者进行了回顾性纵向分析。Deyo-Charlson合并症指数（D-CCI）用于估计合并症的负担。使用抗胆碱能认知负担量表（ACB）和药物负担指数（DBI）量表评估抗胆碱能负担。根据电子病历确定全因出院后死亡率。
■本研究纳入了255名接受了选择性心脏手术并随访至少6个月的老年人。大约12.5％（n=32）的老年患者在出院后6个月内死亡。在多元Cox回归分析中，ACB（HR：1.31，95CI：1.10-1.56p=0.01）和DBI（HR：2.08，95CI：1.27-3.39p=0.01）在校正了几种可能的混杂因素后，显示出出院后6个月死亡率的风险显着增加（年龄，性别,D-CCl,和美国麻醉医师协会（ASA）评分）。根据分组分层ACB和DBI量表的抗胆碱能负荷，接受心脏手术的患者之间的总无事件生存率存在显着差异（χ2：5.907，对数秩检验，p=0.015和χ2：15.389，对数秩检验，p分别<0.001)。
■抗胆碱能负荷与老年心脏手术患者6个月全因出院后死亡率相关。应该考虑一种无效的方法，尤其是围手术期的老年人。
