Mild cognitive impairment in high-risk patients with chronic atrial fibrillation: a forgotten component of clinical management?

Heart. 2013 Apr;99(8):542-7. doi: 10.1136/heartjnl-2012-303182. Epub 2013 Jan 12.

Abstract

Objective: We examined cognitive function in older hospitalised patients with chronic atrial fibrillation (AF).

Design: A prospective substudy of a multicentre randomised trial of an AF-specific disease management intervention (the Standard versus Atrial Fibrillation spEcific managemenT studY; SAFETY).

Setting: Three tertiary referral hospitals within Australia.

Patients: A total of 260 patients with chronic AF: mean age 72±11 years, 53% men, mean CHA2DS2-VASc score 4±2.

Interventions: Cognitive function was assessed at baseline (during inpatient stay) using the Montreal Cognitive Assessment (MoCA).

Main outcome measures: The extent of mild cognitive impairment (MCI-defined as a MoCA score <26) in AF patients and identification of independent predictors of MCI.

Results: Overall, 169 patients (65%, 95% CI 59% to 71%) were found to have MCI at baseline (mean MoCA score 21±3). Multiple deficits in cognitive domains were identified, most notably in executive functioning, visuospatial abilities and short-term memory. Predictors of MCI (age and sex-adjusted) were lower education level (technical/trade school level OR 6.00, 95% CI 2.07 to 17.42; <8 years school education OR 5.29, 95% CI 1.95 to 14.36 vs 8-13 years), higher CHA2DS2-VASc score (OR 1.46, 95% CI 1.23 to 1.74) and prescribed digoxin (OR 2.19, 95% CI 1.17 to 4.10).

Conclusions: MCI is highly prevalent amongst typically older high-risk patients hospitalised with AF. Routine assessment of cognitive function with adjustment of clinical management is indicated for this patient group.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / therapy*
  • Attention
  • Australia / epidemiology
  • Cardiotonic Agents / therapeutic use
  • Chronic Disease
  • Cognition*
  • Cognitive Dysfunction / diagnosis
  • Cognitive Dysfunction / epidemiology*
  • Cognitive Dysfunction / psychology
  • Digoxin / therapeutic use
  • Educational Status
  • Executive Function
  • Female
  • Humans
  • Linear Models
  • Male
  • Memory, Short-Term
  • Middle Aged
  • Multivariate Analysis
  • Neuropsychological Tests
  • Odds Ratio
  • Orientation
  • Prevalence
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Tertiary Care Centers

Substances

  • Cardiotonic Agents
  • Digoxin