Introduction Cholinesterase inhibitors (ChEIs) are the primary medication for dementia treatment. Bradycardia is a potential adverse effect associated with ChEIs. However, the relationship between ChEIs and bradycardia has not been definitively established, particularly in the Asian population. We conducted a study investigating the association between ChEIs and heart rate. Methods We retrieved data from electronic medical records (EMR) of patients aged over 60 who were diagnosed with mild cognitive impairment or dementia at Ramathibodi Hospital between January 2009 and December 2022. These patients had outpatient records at 3, 6, and 12 months after the diagnosis. After filtering out by eligibility criterias, patients were categorised into ChEIs and non-ChEIs use, and then were 1:1 matched by baseline characteristics. We compared heart rate changes between the groups using Student’s t-tests or Mann Whitney U test depending on their distribution and Bayesian linear regression. Bradycardia was analysed using Kaplan–Meier Estimates and Cox proportional hazards model. Results 790 eligible patients were included, with 395 patients in each group. The median of difference of changes from baseline heart rate between group were − 0.5 BPM (p = 0.06), −1.5 BPM (p = 0.12), and − 1.5 BPM (p = 0.002) at 3, 6, and 12 months, respectively. The bradycardia incidence was higher in the ChEIs group (38.5%) compared with the non-ChEIs group (30.6%) at 12 months, but this difference was not statistically significant (p = 0.2). Among all regarded variables, baseline heart rate, age and beta-blocker usage associated with bradycardia, with adjusted hazard ratios (aHR) = 0.888 (95% CI 0.873–0.904, p < 0.001), 1.019 (95% CI 1.001–1.037, p = 0.035) and 1.334 (95% CI 1.045–1.703, p = 0.021). Conclusions The use of ChEIs was found to be associated with a decrease in heart rate. However, the changes were minimal and may not have had clinical implications for the patient.

中文翻译：

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2289 痴呆老年人心率与胆碱酯酶使用的关系：一项回顾性队列研究


简介 胆碱酯酶抑制剂 （ChEIs） 是治疗痴呆的主要药物。心动过缓是与 ChEIs 相关的潜在不良反应。然而，ChEIs 与心动过缓之间的关系尚未明确确定，尤其是在亚洲人群中。我们进行了一项研究，调查了 ChEIs 与心率之间的关联。方法 我们从 2009 年 1 月至 2022 年 12 月期间在 Ramathibodi 医院被诊断患有轻度认知障碍或痴呆的 60 岁以上患者的电子病历 （EMR） 中检索数据。这些患者在诊断后 3 、 6 和 12 个月有门诊记录。在按资格标准过滤后，将患者分为 ChEIs 和非 ChEIs 使用，然后按基线特征进行 1：1 匹配。我们使用 Student t 检验或 Mann Whitney U 检验根据分布和贝叶斯线性回归比较了各组之间的心率变化。使用 Kaplan-Meier 估计和 Cox 比例风险模型分析心动过缓。结果 共纳入 790 例符合条件的患者，每组 395 例患者。在 3 、 6 和 12 个月时，组间心率变化与基线心率变化的中位数分别为 -0.5 BPM （p = 0.06）、-1.5 BPM （p = 0.12） 和 -1.5 BPM （p = 0.002）。12 个月时，ChEIs 组 （38.5%） 的心动过缓发生率高于非 ChEIs 组 （30.6%），但这种差异无统计学意义 （p = 0.2）。在所有考虑的变量中，与心动过缓相关的基线心率、年龄和 β 受体阻滞剂使用，调整后的风险比 （aHR） = 0.888 （95% CI 0.873–0.904，p < 0.001）、1.019 （95% CI 1.001–1.037，p = 0.035） 和 1.334 （95% CI 1.045–1.703，p = 0.021）。 结论 发现 ChEIs 的使用与心率降低相关。然而，这些变化很小，可能对患者没有临床意义。