Hearing loss and cognitive decline among older adults with atrial fibrillation: the SAGE-AF study

Objective: To examine the association between hearing loss and cognitive function cross-sectionally and prospectively among older adults with atrial fibrillation (AF).

Methods: Patients with AF ≥ 65-year-old (n = 1244) in the SAGE (Systematic Assessment of Geriatric Elements)-AF study were recruited from five internal medicine or cardiology clinics in Massachusetts and Georgia. Hearing was assessed by a structured questionnaire at baseline. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at baseline and one year. Cognitive impairment was defined as score ≤ 23 on the MoCA. The associations between hearing loss and cognitive function were examined by multivariable adjusted logistic regression.

Results: Participants with hearing loss (n = 451, 36%) were older, more likely to be male, and have depressive symptoms than patients without hearing loss. At baseline, 528 (42%) participants were cognitively impaired. Individuals with hearing loss were significantly more likely to have cognitive impairment at baseline [adjusted odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.05-1.81]. Among the 662 participants who did not have cognitive impairment at baseline and attended the one-year follow-up visit, 106 (16%) developed incident cognitive impairment. Individuals with, versus those without, hearing loss were significantly more likely to develop incident cognitive impairment at one year (adjusted OR = 1.68, 95% CI: 1.07-2.64).

Conclusions: Hearing loss is a prevalent but under-recognized factor associated with cognitive impairment in patients with AF. Assessment for hearing loss may be indicated among these patients to identify individuals at high-risk for adverse outcomes.