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Cognitive impairment in patients with atrial fibrillation: Implications for outcome in a cohort study

Vincenzo Livio Malavasi1, Cristina Zoccali1, Maria Chiara Brandi1

  • 1Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.

International Journal of Cardiology
|August 18, 2020
PubMed

Insights

Cognitive impairment in atrial fibrillation (AF) patients is linked to worse health outcomes, including mortality. Early identification and appropriate antithrombotic treatment may improve prognosis for these individuals.

Area of Science:

  • Cardiology
  • Neurology
  • Geriatrics

Background:

  • The impact of cognitive status on patient outcomes in atrial fibrillation (AF) is not well-defined.
  • Cognitive impairment is a common comorbidity in elderly populations, potentially affecting AF management and prognosis.

Purpose of the Study:

  • To determine the prevalence of cognitive impairment in patients with AF.
  • To evaluate the association between cognitive impairment and adverse outcomes, including all-cause mortality and a composite endpoint of major cardiovascular events.

Main Methods:

  • A cohort study involving 437 AF patients was conducted.
  • Cognitive status was assessed at baseline using the age and education-adjusted Mini Mental State Examination (aMMSE), with scores below 24 indicating impairment.
  • Outcomes, including mortality and a composite endpoint, were tracked over a median follow-up of 887 days.

Main Results:

  • 14.4% of patients exhibited cognitive impairment at baseline.
  • Cognitive impairment was independently associated with permanent AF, lower hemoglobin levels, and prior antiplatelet-only treatment.
  • After adjusting for comorbidities, cognitive impairment (aMMSE <24) significantly increased the risk of all-cause mortality (HR 2.473) and the composite endpoint (HR 1.852).

Conclusions:

  • Cognitive impairment in AF patients is associated with significantly worse clinical outcomes.
  • The findings underscore the importance of assessing cognitive function in AF patients.
  • Appropriate antithrombotic treatment, particularly avoiding antiplatelet monotherapy in favor of oral anticoagulation, may be crucial for improving prognosis in this vulnerable population.
Abstract

Keywords:
AnticoagulationAtrial fibrillationCognitive impairmentMini-mental state examinationMortalityOutcome

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