Atrial fibrillation was associated with an increased risk of cognitive decline (HR 1.14; 95% CI 1.03-1.26), incident dementia, and loss of independence in patients at high cardiovascular risk.
Cohort (n=31,506)
Does atrial fibrillation increase the risk of cognitive and functional decline in patients at high cardiovascular risk?
Atrial fibrillation is independently associated with an increased risk of cognitive decline, dementia, and loss of independence, even in the absence of overt stroke.
Hazard Ratio: 1.14 (95% CI 1.03–1.26)
BACKGROUND: The role of atrial fibrillation in cognitive impairment and dementia, independent of stroke, is uncertain. We sought to determine the association of atrial fibrillation with cognitive and physical impairment in a large group of patients at high cardiovascular risk. METHODS: We conducted a post-hoc analysis of two randomized controlled trials involving 31,546 patients, the aims of which were to evaluate the efficacy of treatment with ramipril plus telmisartan (ONTARGET) or telmisartan alone (TRANSCEND) in reducing cardiovascular disease. We evaluated the cognitive function of participants at baseline and after two and five years using the Mini-Mental State Examination (MMSE). In addition, we recorded incident dementia, loss of independence in activities of daily living and admission to long-term care facilities. We used a Cox regression model adjusting for main confounders to determine the association between atrial fibrillation and our primary outcomes: a decrease of three or more points in MMSE score, incident dementia, loss of independence in performing activities of daily living and admission to long-term care. RESULTS: We enrolled 31,506 participants for whom complete information on atrial fibrillation was available, 70.4% of whom were men. The mean age of participants was 66.5 years, and the mean baseline MMSE score was 27.7 (standard deviation 2.9) points. At baseline, 1016 participants (3.3%) had atrial fibrillation, with the condition developing in an additional 2052 participants (6.5%) during a median follow-up of 56 months. Atrial fibrillation was associated with an increased risk of cognitive decline (hazard ratio HR 1.14, 95% confidence interval CI 1.03-1.26), new dementia (HR 1.30, 95% CI 1.14-1.49), loss of independence in performing activities of daily living (HR 1.35, 95% CI 1.19-1.54) and admission to long-term care facilities (HR 1.53, 95% CI 1.31-1.79). Results were consistent among participants with and without stroke or receiving antihypertensive drugs. INTERPRETATION: Cognitive and functional decline are important consequences of atrial fibrillation, even in the absence of overt stroke.
Marzona et al. (Mon,) llevaron a cabo una cohorte en alto riesgo cardiovascular (n=31,506). Se evaluó la fibrilación auricular vs. No fibrilación auricular sobre la disminución de tres o más puntos en la puntuación MMSE (deterioro cognitivo) (HR 1.14, 95% CI 1.03-1.26). La fibrilación auricular se asoció con un aumento del riesgo de deterioro cognitivo (HR 1.14; 95% CI 1.03-1.26), demencia incidente y pérdida de independencia en pacientes de alto riesgo cardiovascular.