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The influence of cholinesterase inhibitor therapy for dementia on risk of cardiac pacemaker insertion: a retrospective, population-based, health administrative databases study in Ontario, Canada.

Huang AR, Redpath CJ, van Walraven C - BMC Neurol (2015)

Bottom Line: Since these drugs have a marginal impact on patient outcomes, it might be preferable to change drug treatment rather than implant a pacemaker.Adjustment for patient age, sex, and other medications did not notably change results, as did restricting the analysis to incident users.Patients taking cholinesterase inhibitors rarely undergo, and have a significantly reduced risk of, cardiac pacemaker insertion.

View Article: PubMed Central - PubMed

Affiliation: Division of Geriatric Medicine, Department of Medicine, University of Ottawa, The Ottawa Hospital, Box 678, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada. allenhuang@toh.on.ca.

ABSTRACT

Background: Cholinesterase inhibitors are used to treat the symptoms of dementia and can theoretically cause bradycardia. Previous studies suggest that patients taking these medications have an increased risk of undergoing pacemaker insertion. Since these drugs have a marginal impact on patient outcomes, it might be preferable to change drug treatment rather than implant a pacemaker. This population-based study determined the association of people with dementia exposed to cholinesterase inhibitor medication and pacemaker insertion.

Methods: We used data from the Ontario health administrative databases from January 1, 1993 to June 30, 2012. We included all community-dwelling seniors who had a code for dementia and were exposed to cholinesterase inhibitors (donezepil, galantamine, and rivastigmine) and/or drugs used to treat co-morbidities of hypertension, diabetes, depression and hypothyroidism. We controlled for exposure to anti-arrhythmic drugs. Observation started at first exposure to any medication and continued until the earliest of pacemaker insertion, death, or end of study.

Results: 2,353,909 people were included with 96,000 (4.1%) undergoing pacemaker insertion during the observation period. Case-control analysis showed that pacemaker patients were less likely to be coded with dementia (unadjusted OR 0.42 [95%CI 0.41-0.42]) or exposed to cholinesterase inhibitors (unadjusted OR 0.39 [95%CI 0.37-0.41]). That Cohort analysis showed patients with dementia taking cholinesterase inhibitors had a decreased risk of pacemaker insertion (unadj-HR 0.58 [0.55-0.61]). Adjustment for patient age, sex, and other medications did not notably change results, as did restricting the analysis to incident users.

Conclusions: Patients taking cholinesterase inhibitors rarely undergo, and have a significantly reduced risk of, cardiac pacemaker insertion.

No MeSH data available.


Related in: MedlinePlus

Schematic of the study cohort selection.
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Fig1: Schematic of the study cohort selection.

Mentions: The study’s primary outcome was pacemaker insertion. This was determined by linking to DAD to identify any subsequent encounter in which a pacemaker insertion was coded (Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures codes 49.7, 49.71, 49.72, 49.73, or 51.64; Canadian Classification of Health Interventions starting with 1HD53, 1HZ37, 1HZ53, or 1HB53). We included any surgical type (i.e. we did not restrict outcomes to those classified as primary). Patients were excluded from the analysis if a pacemaker had been inserted prior to the start of their observation. Figure 1 shows a schematic of the selection of the study cohorts.Figure 1


The influence of cholinesterase inhibitor therapy for dementia on risk of cardiac pacemaker insertion: a retrospective, population-based, health administrative databases study in Ontario, Canada.

Huang AR, Redpath CJ, van Walraven C - BMC Neurol (2015)

Schematic of the study cohort selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4419497&req=5

Fig1: Schematic of the study cohort selection.
Mentions: The study’s primary outcome was pacemaker insertion. This was determined by linking to DAD to identify any subsequent encounter in which a pacemaker insertion was coded (Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures codes 49.7, 49.71, 49.72, 49.73, or 51.64; Canadian Classification of Health Interventions starting with 1HD53, 1HZ37, 1HZ53, or 1HB53). We included any surgical type (i.e. we did not restrict outcomes to those classified as primary). Patients were excluded from the analysis if a pacemaker had been inserted prior to the start of their observation. Figure 1 shows a schematic of the selection of the study cohorts.Figure 1

Bottom Line: Since these drugs have a marginal impact on patient outcomes, it might be preferable to change drug treatment rather than implant a pacemaker.Adjustment for patient age, sex, and other medications did not notably change results, as did restricting the analysis to incident users.Patients taking cholinesterase inhibitors rarely undergo, and have a significantly reduced risk of, cardiac pacemaker insertion.

View Article: PubMed Central - PubMed

Affiliation: Division of Geriatric Medicine, Department of Medicine, University of Ottawa, The Ottawa Hospital, Box 678, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada. allenhuang@toh.on.ca.

ABSTRACT

Background: Cholinesterase inhibitors are used to treat the symptoms of dementia and can theoretically cause bradycardia. Previous studies suggest that patients taking these medications have an increased risk of undergoing pacemaker insertion. Since these drugs have a marginal impact on patient outcomes, it might be preferable to change drug treatment rather than implant a pacemaker. This population-based study determined the association of people with dementia exposed to cholinesterase inhibitor medication and pacemaker insertion.

Methods: We used data from the Ontario health administrative databases from January 1, 1993 to June 30, 2012. We included all community-dwelling seniors who had a code for dementia and were exposed to cholinesterase inhibitors (donezepil, galantamine, and rivastigmine) and/or drugs used to treat co-morbidities of hypertension, diabetes, depression and hypothyroidism. We controlled for exposure to anti-arrhythmic drugs. Observation started at first exposure to any medication and continued until the earliest of pacemaker insertion, death, or end of study.

Results: 2,353,909 people were included with 96,000 (4.1%) undergoing pacemaker insertion during the observation period. Case-control analysis showed that pacemaker patients were less likely to be coded with dementia (unadjusted OR 0.42 [95%CI 0.41-0.42]) or exposed to cholinesterase inhibitors (unadjusted OR 0.39 [95%CI 0.37-0.41]). That Cohort analysis showed patients with dementia taking cholinesterase inhibitors had a decreased risk of pacemaker insertion (unadj-HR 0.58 [0.55-0.61]). Adjustment for patient age, sex, and other medications did not notably change results, as did restricting the analysis to incident users.

Conclusions: Patients taking cholinesterase inhibitors rarely undergo, and have a significantly reduced risk of, cardiac pacemaker insertion.

No MeSH data available.


Related in: MedlinePlus