Key result
Mild cognitive impairment linked to ~233% higher odds of polypharmacy versus severe impairment in AF.
Why the study?
The association between cognitive impairment severity and polypharmacy in patients with atrial fibrillation prone to cognitive decline was unclear, and the utility of DASC-21 severity classification for drug adjustment needed elucidation.
Is cognitive impairment severity associated with polypharmacy in older inpatients with atrial fibrillation?
Cohort (n=1,191)
No
Is cognitive impairment severity associated with polypharmacy in older inpatients with atrial fibrillation?
Odds Ratio: 3.33 (95% CI 1.29–8.57)
In older inpatients with atrial fibrillation, mild and moderate cognitive impairment are associated with a higher likelihood of polypharmacy compared to severe cognitive impairment, suggesting cognitive severity may guide drug adjustment.
May support DASC-21-guided polypharmacy review in cognitively impaired AF; leaves open prospective outcome trials before practice change.
This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29–8.57) and moderate (OR: 2.46, 95% CI: 1.06–5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51–2.95, p < 0.001], 2.42 [95% CI: 1.79–3.27, p < 0.001], and 2.01 [95% CI: 1.46–2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.
No takes yet. Share an insight, caveat, or question.
Shimazaki et al. (2024) conducted a cohort in Atrial fibrillation (n=1,191). Mild cognitive impairment vs. Severe cognitive impairment was evaluated on Polypharmacy (concurrent use of ≥6 medications) (OR 3.33, 95% CI 1.29-8.57). Compared with severe cognitive impairment, mild (OR 3.33; 95% CI 1.29-8.57) and moderate (OR 2.46; 95% CI 1.06-5.72) impairments were associated with higher odds of polypharmacy in AF patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: