Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-26T10:09:15.303Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiac monitoring for cholinesterase inhibitors: a survey

Published online by Cambridge University Press:  16 April 2009

Dirk Maliepaard  and
Tom MacEwan
Dirk Maliepaard*
Affiliation:
University of Aberdeen and Royal Cornhill Hospital, Aberdeen, U.K.
Tom MacEwan
Affiliation:
University of Aberdeen and Royal Cornhill Hospital, Aberdeen, U.K.
*
Correspondence should be addressed to: Dr. Dirk Maliepaard, Specialist Registrar and Honorary Lecturer, University of Aberdeen, Royal Cornhill Hospital, Cornhill Road, Aberdeen, AB25 2ZH, U.K. Phone: + 44 1224 557031; Fax: + 44 1224 557853. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: There is no consensus on the monitoring for rare but potentially serious cardiac adverse events associated with cholinesterase inhibitor drugs in the treatment of dementia. Different protocols have been proposed, with and without ECG examination. We surveyed an urban old age psychiatry service to investigate the variables that may influence the implementation of such protocols.

Methods: Case notes of 45 consecutive patients assessed for dementia were scrutinized, to establish how many underwent an ECG or other cardiac examination prior to drug treatments. Data were collected on demographics, medical conditions and drug treatments. Patient files were searched for indications of investigations and any outcomes.

Results: Half of all patients treated with a cholinesterase inhibitor (11/22) had an ECG before treatment. In five cases no pulse or cardiac symptoms were recorded in the absence of an ECG. Medical history, findings on examination, seniority of the clinician, and patient cooperation all may have influenced whether patients had an ECG. In three cases treatment was not prescribed due to concerns over cardiac effects, and with five ECGs new diagnoses were made. A protocol based on pulse monitoring would only have indicated ECGs in two out of 22 cases.

Conclusions: Several factors may influence decisions on cardiac monitoring. Fewer ECGs could be done if only pulse and cardiac symptoms were monitored before cholinesterase inhibitor prescription, but new cardiac diagnoses might then be missed. Protocols can be devised to incorporate both cardiac investigation and cholinesterase inhibitor monitoring.

Keywords

dementiaECG
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 3 , June 2009 , pp. 457 - 462
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Birks, J. (2006). Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database of Systematic Reviews, 1, CD005593. doi: 10.1002/14651858.CD005593.Google Scholar
Bordier, P. et al. (2005). Causes of syncope in patients with Alzheimer's disease treated with donepezil. Drugs and Aging, 22, 687–694.CrossRefGoogle ScholarPubMed
Bullock, R. (2007). A breath of pragmatism. Invited commentary on cardiovascular monitoring with acetylcholinesterase inhibitors. Advances in Psychiatric Treatment, 13, 185–186.CrossRefGoogle Scholar
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Foy, J. (2008). A survey of memory clinic practice in Scotland. Psychiatric Bulletin, 32, 467–469. doi: 10.1192/pb.bp.107.018614.CrossRefGoogle Scholar
Kayrak, M., Yazici, M., Ayhan, S. S., Koc, F. and Ulgen, M. S. (2008). Complete atrioventricular block associated with rivastigmine therapy. American Journal of Health-System Pharmacy, 65, 1051–1053.CrossRefGoogle ScholarPubMed
López-Pousa, S. et al. (2006). Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil or galantamine. Age and Ageing, 35, 365–371. doi: 10.1093/ageing/afj083CrossRefGoogle ScholarPubMed
Malone, D. M. and Lindesay, J. (2007). Cholinesterase inhibitors and cardiovascular disease: a survey of old age psychiatrists' practice. Age and Ageing, 36, 331–333. doi:10.1093/ageing/afm002CrossRefGoogle ScholarPubMed
Mant, J. et al. (2007). Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretive diagnostic software: analysis of data from Screening for Atrial Fibrillation in the Elderly (SAFE) trial. BMJ, 335, 380–385.CrossRefGoogle ScholarPubMed
Martin, J. (ed.) (2008). British National Formulary. London: RPS Publishing/BMJ Group.Google Scholar
Newby, V. J., Kenny, R. A. and McKeith, I. G. (2004). Donepezil and cardiac syncope: case report. International Journal of Geriatric Psychiatry, 19, 1110–1112.CrossRefGoogle Scholar
Rowland, J. P., Rigby, J., Harper, A. C. and Rowland, R. (2007). Cardiovascular monitoring with acetylcholinesterase inhibitors: a clinical protocol. Advances in Psychiatric Treatment, 13, 178–184.CrossRefGoogle Scholar
Royal College of Psychiatrists (2005). Council Report CR119. Forgetful but not Forgotten: Assessment and Aspects of Treatment of People with Dementia by a Specialist Old Age Psychiatry Service. London: Royal College of Psychiatrists.Google Scholar
Solomons, L., Trelor, A. and Noronha, R. (2008). Competence of psychiatric clinicians in interpreting electrocardiograms and QT intervals: can they do this? Does it matter? Psychiatric Bulletin, 32, 291–294. doi: 10.1192/pb.bp.107.017715.CrossRefGoogle Scholar
Suleyman, T., Tevfik, P., Abdulkadir, G. and Ozlem, S. (2006). Complete atrioventricular block and ventricular tachyarrhythmia associated with donepezil. Emergency Medicine Journal, 23, 641–642. doi: 10.1136/emj.2006.036251CrossRefGoogle ScholarPubMed
Taylor, D., Paton, C. and Kerwin, R. (2007). The Maudsley Prescribing Guidelines. 9th edn. London: Informa Healthcare.CrossRefGoogle Scholar
Waldemar, G. et al. on behalf of the European Dementia Consensus Network (2007). Access to diagnostic evaluation and treatment for dementia in Europe. International Journal of Geriatric Psychiatry, 22, 47–54.CrossRefGoogle ScholarPubMed
Wright, C. A., Osborn, D. P. J., Nazareth, I. and King, M. B. (2006). Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patients and professionals' preferences for care. BMC Psychiatry, 6, 16–27.CrossRefGoogle ScholarPubMed