2289 The association of heart rate and cholinesterase inhibitor use among elders living with dementia: a retrospective cohort study

Abstract 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.