Prescribing anticholinergic drugs to patients with atrial fibrillation and stage 4 chronic kidney disease in real-world clinical practice

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Abstract

Background: Atrial fibrillation (AF) is the most common heart rhythm disorder in the elderly. The combination of AF and chronic kidney disease (CKD), especially against the background of a decreased glomerular filtration rate, creates significant difficulties in choosing optimal pharmacotherapy. Numerous studies demonstrate cognitive decline in patients with AF and CKD, particularly when prescribing drugs with anticholinergic burden (ACB).

Objective: To analyze drug prescriptions in hospitalized patients over 65 years of age with AF and stage 4 CKD from the perspective of anticholinergic burden (ACB) level.

Material and methods: The study included 86 patients divided into 2 groups: group 1 – 27 patients (median age 87 [82;89] years, women – 81,5%) hospitalized in 2018–2019, group 2 – 59 patients (median age 91 [87;93] years, women – 78%) treated in 2022–2023 at the same multidisciplinary hospital in the same departments. The ACB level was assessed using the Anticholinergic Cognitive Burden (ACB) Scale.

Results: In the first group, 14,8% of patients had an ACB score of 1, while in the second group, this proportion was 32,2%. Patients with a total ACB score of 2 were statistically significantly more common in group 1 compared to group 2 (44,4% vs. 11,9%, respectively, p=0,002). The most frequently prescribed drugs with ACB were metoprolol, furosemide, isosorbide dinitrate, digoxin, and prednisolone. Both isolated prescriptions of these drugs and their combinations were identified.

Conclusion: In polymorphic patients, drug prescription should be carried out with extreme caution, especially concerning medications with anticholinergic burden. Appropriate prescription of these drugs should be considered as a method of preventing adverse outcomes in this category of patients.

About the authors

Evgeniya V. Shikh

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: chih@mail.ru
ORCID iD: 0000-0001-6589-7654
SPIN-code: 2397-8414

Dr. Sci. (Med.), Professor, Corr. Member of the Russian Academy of Sciences, Head of the Department of Clinical Pharmacology and Propaedeutics of Internal Medicine at the N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

Sofya S. Eremina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: sofya.eremina@mail.ru
ORCID iD: 0000-0001-7989-354X
SPIN-code: 5630-4333

Postgraduate Student of the Department of Clinical Pharmacology and Propaedeutics of Internal Medicine at the N.V. Sklifosovsky Institute of Clinical Medicine

Russian Federation, Moscow

Elizaveta I. Ebzeeva

Russian Medical Academy of Continuous Professional Education

Email: Еveta-veta67@mail.ru
ORCID iD: 0000-0001-6573-4169

Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Therapy and Polymorbid Pathology named after Academician M.S. Vovsi

Russian Federation, Moscow

Galina F. Piksina

Municipal Clinical Hospital №15 named after O.M. Filatov

Email: galina-piksina@yandex.ru
ORCID iD: 0000-0003-2114-1227

Cand. Sci. (Med.), Cardiologist, acting deputy chief physician for emergency care

Russian Federation, Moscow

Natalya V. Orlova

Pirogov Russian National Research Medical University

Email: vrach315@yandex.ru
ORCID iD: 0000-0002-4293-3285

Dr. Sci. (Med.), Professor, Professor of the Department of Faculty Therapy at the Institute of Medical Sciences

Russian Federation, Moscow

Olga D. Ostroumova

I.M. Sechenov First Moscow State Medical University (Sechenov University); Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0002-0795-8225
SPIN-code: 3910-6585

Dr. Sci. (Med.), Professor, Head of the Department of Therapy and Polymorbid Pathology named after Academician M.S. Vovsi, Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases

Russian Federation, Moscow; Moscow

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