Anticholinergic burden and its associated factors among adult outpatients in a resource-limited setting: a cross-sectional study

Existing evidence links anticholinergic burden (ACB), the cumulative effect of medicines with anticholinergic activity, with serious adverse effects. There is scarcity of evidence on the extent of use of such medicines in Ethiopian outpatient settings. To assess the prevalence and determinants of high ACB (score ≥ 3) among adult patients, a cross-sectional study was conducted among adult patients (≥ 18 years) attending ambulatory clinic of University of Gondar Comprehensive Specialized Hospital (UoGCSH) between April and September 2022. ACB was calculated based on the medications patients were currently taking, identified from medical records and patient interviews. Descriptive statistics were used to summarize socio-demographic and clinical characteristics of participants. Logistic regression analysis was used to identify factors associated with high ACB (ACB score ≥ 3). 409 patients, median age 50 years (IQR 37-62, range 18-85), participated in this study. About a third (32%) of participants were exposed to at least one medication with anticholinergic activity. Approximately one-tenth (9.5%) of them were exposed to high ACB. Logistic regression analysis indicated that the increase in the number of medications was associated with a 1.57-fold (AOR 1.57; 95% CI 1.22-2.02) increase in the odds of high ACB. Medicines with anticholinergic activity are commonly prescribed to outpatients at UoGSCH, despite relatively younger demographics. When prescribing multiple medicines with anticholinergic properties, physicians need to be cautious as high ACB is cumulative.