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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: dirk.maliepaard@nhs.net.
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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

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