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Published on: February 26, 2013
Atrial fibrillation and cognitive function in patients with heart failure: a systematic review and meta-analysis
Pavlos G Myserlis1,2, Antonia Malli3,4, Dimitrios K Kalaitzoglou3,4
1Society of Junior Doctors, Athens, Greece. pmyserlis@sni.gr.
Insights
Atrial fibrillation (AF) significantly increases the risk of cognitive impairment in heart failure (HF) patients. Further research is needed to confirm this link and explore underlying mechanisms for potential interventions.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Cognitive impairment and dementia are known complications of heart failure (HF).
- Atrial fibrillation (AF) may independently contribute to cognitive decline in HF patients.
- Medication adherence and self-care are negatively impacted by cognitive deficits in HF.
Purpose of the Study:
- To systematically review and assess the effect of AF on cognitive function in patients with HF.
- To synthesize evidence from primary research articles evaluating the AF-cognition relationship in HF.
Main Methods:
- Systematic review of Medline (PubMed), Scopus, and CENTRAL databases up to April 30, 2016.
- Inclusion of five primary research articles with 1670 HF patients (449 with AF).
- Meta-analysis using inverse variance and random effects models to determine the odds ratio (OR) for cognitive impairment.
Main Results:
- The presence of AF was significantly associated with an increased risk of cognitive impairment in HF patients (OR, 1.94; 95% CI, 1.30-2.87).
- Significant heterogeneity (I² = 39%) was observed, attributed to variations in study populations, AF types, and cognitive assessment tools.
- Four cognitive tests were utilized across the included studies.
Conclusions:
- Concomitant AF may exacerbate cognitive dysfunction in patients with HF.
- Current data are sparse and heterogeneous, necessitating well-designed, prospective studies.
- Future research should aim to establish a causative link and identify mechanisms for targeted interventions.
Abstract:
Cognitive impairment and dementia are established complications of heart failure (HF) in adult patients and impair medication adherence and self-care. Atrial fibrillation (AF) is suggested to play an independent role in the cognitive decline in patients with HF. The objective of this systematic review was to assess the effect of AF on cognitive function in these patients. Medline (PubMed), Scopus, and the CENTRAL databases were queried from their inception up to April 30, 2016. The search included primary research articles evaluating the effect of AF on cognition in HF patients. There were five eligible studies, including a total of 1670 patients with HF; of these, 449 (26.9%) had AF. Different AF types were studied, including persistent, paroxysmal, or permanent. Four cognitive tests were used to assess cognitive function (Mini-Mental State Examination, Short Portable Mental Status Questionnaire, Modified Mini-Mental Examination, and Montreal cognitive assessment tool). Using the inverse variance method and a random effects model, we observed that presence of AF was significantly associated with increased risk of cognitive impairment in HF patients (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.30-2.87), although with significant heterogeneity (I 2 = 39%). This heterogeneity can be attributed to the different populations and types of AF studied as well as to varying cognitive assessment methods. Concomitant AF may exacerbate cognitive dysfunction in HF patients. However, data are sparse and heterogeneous. Well-designed, prospective studies are needed to (a) establish a causative link and (b) identify the underlying mechanism in order to design appropriate interventions to attenuate risk of cognitive impairment in patients with HF.
