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Geriatrics

Session: Poster Session B

(138) Risk of ventricular arrhythmias or sudden cardiac death and acetylcholinesterase inhibitors among older adults with dementia

Tuesday, August 27, 2024
8:00 AM – 6:00 PM CEST
Location: Convention Hall II

    Co-Author(s)

  • YY

    Yi-Jia Ye

    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, Taiwan (Republic of China)

    • Presenting Author(s)

  • HL

    Hsi-Yu Lai, MS

    Research associate
    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, Taiwan (Republic of China)

    • Co-Author(s)

  • Lin-Chieh Meng, MS

    PhD student
    Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Taiwan (Republic of China)

  • HC

    Hui-Min Chuang

    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, Taiwan (Republic of China)

  • LC

    Liang-Kung Chen, MD,PhD

    Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, Taiwan (Republic of China)

  • FH

    Fei-Yuan Hsiao, PhD

    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, Taiwan (Republic of China)

Background: Existing studies have linked the risk of ventricular arrhythmias or sudden cardiac death and acetylcholinesterase inhibitors (AChEIs). Nevertheless, comparative risk of severe cardiac conduction problems due to QTc prolongation across the three available AChEIs (donepezil, galantamine, and rivastigmine) in real‐world setting remained unanswered.

Objectives: The study aimed to investigate the risk of ventricular arrhythmias or sudden cardiac death and the use of three different AChEIs (donepezil, galantamine, and rivastigmine) in older adults with dementia.

Methods: We conducted a retrospective cohort study using Taiwan’s National Health Insurance database. Older adults with dementia who had ever prescribed AChEIs between 2010 and 2019 were identified and further categorized into three groups based on the AChEI they received. Stabilized inverse probability of treatment weighting (IPTW) was used to balance potential confounders between donepezil or galantamine and rivastigmine (as control group). Cox proportional hazard models were used to examine the risks of ventricular arrhythmias or sudden cardiac death between the groups.

Results: A total of 64,425 older adults with dementia who had been prescribed AChEI for the first time in 2010-2019 were identified. Approximately 65% patients (n=41,640, 64.6%) were prescribed donepezil, followed by rivastigmine (n=21,297, 33.1%), and galantamine (n=1,488, 2.3%) . Risk of ventricular arrhythmias or sudden cardiac death was comparable between donepezil and rivastigmine (adjusted hazard ratio (aHR) 0.97 [95% confidence interval (CI) 0.84-1.12]). However, galantamine was associated with a higher risk of ventricular arrhythmias or sudden cardiac death (aHR 1.86 [1.53-2.25]) compared with rivastigmine group.

Conclusions: The risk of ventricular arrhythmia or sudden cardiac death in older adults with dementia was comparable between donepezil and rivastigmine. However, galantamine was associated with a higher risk of ventricular arrhythmia or sudden cardiac as compared with rivastigmine. Further researches are warranted to verify the different risk of ventricular arrhythmias or sudden cardiac death associated with different AChEIs.