Cognitive impairment in patients with atrial fibrillation: Implications for outcome in a cohort study
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Cognitive impairment in patients with atrial fibrillation: Implications for outcome in a cohort study. / Malavasi, Vincenzo Livio; Zoccali, Cristina; Brandi, Maria Chiara; Micali, Giulia; Vitolo, Marco; Imberti, Jacopo Francesco; Mussi, Chiara; Schnabel, Renate B; Freedman, Ben; Boriani, Giuseppe.
in: INT J CARDIOL, Jahrgang 323, 15.01.2021, S. 83-89.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Cognitive impairment in patients with atrial fibrillation: Implications for outcome in a cohort study
AU - Malavasi, Vincenzo Livio
AU - Zoccali, Cristina
AU - Brandi, Maria Chiara
AU - Micali, Giulia
AU - Vitolo, Marco
AU - Imberti, Jacopo Francesco
AU - Mussi, Chiara
AU - Schnabel, Renate B
AU - Freedman, Ben
AU - Boriani, Giuseppe
N1 - Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.
PY - 2021/1/15
Y1 - 2021/1/15
N2 - BACKGROUND: The impact of cognitive status on outcomes of patients with atrial fibrillation (AF) is not well defined.AIMS: To assess the prevalence of cognitive impairment in AF patients and evaluate its association with: i) all-cause mortality; ii) a composite endpoint of death, stroke/systemic embolism, hemorrhages, acute coronary syndrome, pulmonary embolism, new/worsening heart failure.METHODS: In a cohort study, cognitive status was assessed at baseline by the Mini Mental State examination adjusted for age and education (aMMSE). aMMSE <24 was considered indicative of cognitive impairment.RESULTS: The cohort included 437 patients (61.3% male, mean age 73.4 ± 11.7 years). Sixty-three patients (14.4%) had cognitive impairment at baseline aMMSE. Permanent AF (odds ratio [OR] 1.750; 95%CI 1.012-3.025; p = .045), haemoglobin levels (OR 0.827; 95%CI 0.707-0.967; p = .017) and previous treatment with antiplatelet drugs only, without oral anticoagulation, (OR 4.352; 95%CI 1.583-11.963; p = .004) were independently associated with cognitive impairment at baseline. After a median follow-up of 887 days (interquartile range 731-958) 30 patients died (7.1%), and 97 (22.9%) reached the composite endpoint. After adjustment for Elixhauser Comorbidy Measure, aMMSE <24 was significantly associated with all-cause mortality (hazard ratio [HR] 2.473, 95%CI 1.062-5.756, p = .036) and with the composite endpoint (HR 1.852, 95%CI 1.106-3.102, p = .019).CONCLUSIONS: In patients with AF, cognitive impairment (aMMSE <24) is associated with worse outcomes, and the association of adverse outcomes with previous treatment with antiplatelet drugs only, without oral anticoagulation, highlights the potential role of appropriate antithrombotic treatment for improving patient prognosis.
AB - BACKGROUND: The impact of cognitive status on outcomes of patients with atrial fibrillation (AF) is not well defined.AIMS: To assess the prevalence of cognitive impairment in AF patients and evaluate its association with: i) all-cause mortality; ii) a composite endpoint of death, stroke/systemic embolism, hemorrhages, acute coronary syndrome, pulmonary embolism, new/worsening heart failure.METHODS: In a cohort study, cognitive status was assessed at baseline by the Mini Mental State examination adjusted for age and education (aMMSE). aMMSE <24 was considered indicative of cognitive impairment.RESULTS: The cohort included 437 patients (61.3% male, mean age 73.4 ± 11.7 years). Sixty-three patients (14.4%) had cognitive impairment at baseline aMMSE. Permanent AF (odds ratio [OR] 1.750; 95%CI 1.012-3.025; p = .045), haemoglobin levels (OR 0.827; 95%CI 0.707-0.967; p = .017) and previous treatment with antiplatelet drugs only, without oral anticoagulation, (OR 4.352; 95%CI 1.583-11.963; p = .004) were independently associated with cognitive impairment at baseline. After a median follow-up of 887 days (interquartile range 731-958) 30 patients died (7.1%), and 97 (22.9%) reached the composite endpoint. After adjustment for Elixhauser Comorbidy Measure, aMMSE <24 was significantly associated with all-cause mortality (hazard ratio [HR] 2.473, 95%CI 1.062-5.756, p = .036) and with the composite endpoint (HR 1.852, 95%CI 1.106-3.102, p = .019).CONCLUSIONS: In patients with AF, cognitive impairment (aMMSE <24) is associated with worse outcomes, and the association of adverse outcomes with previous treatment with antiplatelet drugs only, without oral anticoagulation, highlights the potential role of appropriate antithrombotic treatment for improving patient prognosis.
KW - Aged
KW - Aged, 80 and over
KW - Anticoagulants
KW - Atrial Fibrillation/diagnosis
KW - Cognitive Dysfunction/diagnosis
KW - Cohort Studies
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Risk Factors
KW - Stroke
U2 - 10.1016/j.ijcard.2020.08.028
DO - 10.1016/j.ijcard.2020.08.028
M3 - SCORING: Journal article
C2 - 32800908
VL - 323
SP - 83
EP - 89
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -