Background Prescribing cholinesterase inhibitors (ChEIs) concurrently with beta-blockers might cause syncope that increases the risk of fall-related injuries (FRIs). This self-controlled case series study assesses the risk of FRIs associated with initiating ChEIs while receiving beta-blockers among Medicare fee-for-service-insured nursing home (NH) residents in the United States. Methods We identified individuals at their first dispensing of a beta-blocker between 2016 and 2019 after at least 45 days of long-stay NH residency. Individuals were followed from the first day of beta-blocker use until beta-blocker discontinuation, Medicare disenrollment, death, or study end. ChEI initiation was classified as the first 60 days of new ChEI dispensing after 45 days of no ChEI exposure. FRIs were assessed during beta-blocker use periods and age-adjusted incidence rate ratios (IRR) for ChEI-initiation days versus other days were calculated using conditional Poisson regression models. Analyses were weighted for event-dependent observation periods due to the high risk of mortality after an FRI in this population. Subgroup analyses were conducted for several key time-fixed variables, including sex, age, ChEI type, ChEI dose, beta-blocker selectivity and beta-blocker dose. Results The FRI risk after ChEI initiation was not elevated among 837 residents who experienced an FRI while using beta-blockers (IRR=0.90 [95%CLs 0.71, 1.15]). Analyses of ChEI initiation in several subgroups yielded similar results. Conclusions There was no substantial difference in FRI risk when initiating ChEIs among older NH residents receiving beta-blocker therapy versus periods without ChEI initiation, suggesting that there is no clinically significant pharmacodynamic drug-drug interaction between beta-blockers and ChEIs.

中文翻译：

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胆碱酯酶抑制剂的启动不会增加接受 β 受体阻滞剂治疗的老年人跌倒相关损伤的风险：一种自我对照的病例系列设计


背景 与 β 受体阻滞剂同时开具胆碱酯酶抑制剂 （ChEI） 可能会导致晕厥，从而增加跌倒相关伤害 （FRIs） 的风险。这项自我对照病例系列研究评估了美国 Medicare 按服务收费保险的疗养院 （NH） 居民在接受 β 受体阻滞剂时与启动 ChEI 相关的 FRI 风险。方法 我们确定了 2016 年至 2019 年间在 NH 长期居住至少 45 天后首次分配 β 受体阻滞剂的个体。从使用 β 受体阻滞剂的第一天开始随访个体，直至 β 受体阻滞剂停药、Medicare 退保、死亡或研究结束。ChEI 开始被归类为在没有 ChEI 暴露 45 天后前 60 天分配新 ChEI。在 β 受体阻滞剂使用期间评估 FRIs，并使用条件泊松回归模型计算 ChEI 开始天数与其他天数的年龄调整发病率比 （IRR）。由于该人群 FRI 后死亡风险高，因此对事件依赖性观察期进行加权分析。对几个关键时间固定变量进行亚组分析，包括性别、年龄、 ChEI 类型、 ChEI 剂量、 β 受体阻滞剂选择性和 β 受体阻滞剂剂量。结果 837 例在使用β受体阻滞剂时出现FRI的居民中，ChEI开始后的FRI风险并不升高（IRR=0.90 [95%CLs 0.71,1.15]）。对几个亚组中 ChEI 起始的分析产生了相似的结果。 结论 接受 β 受体阻滞剂治疗的老年 NH 居民与未开始 ChEI 的时期开始 ChEIs 时 FRI 风险无显著差异，表明 β 受体阻滞剂和 ChEIs 之间没有临床显着的药效学药物相互作用。