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Atrial Fibrillation: Possible Influences of Rate and Rhythm Control Strategy on Cognitive Performance
Author(s) -
Damanti Sarah,
Pasina Luca,
Cortesi Laura,
Rossi Paolo D.,
Cesari Matteo
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15568
Subject(s) - medicine , atrial fibrillation , odds ratio , confidence interval , rhythm , logistic regression , cognition , heart rhythm , retrospective cohort study , cardiology , pediatrics , physical therapy , psychiatry
Objectives To determine whether rate or rhythm control strategy may affect cognition in older adults with atrial fibrillation (AF). Design Retrospective analysis of the REgistro POliterapie SIMI database. Setting Italian internal medicine and geriatric wards. Participants Individuals aged 65 and older (N=1,082, mean age 80.6 ± 7; 50% male) with AF before hospital admission (for any cause). Measurements Evaluation of cognitive performance using the Short Blessed Test (SBT) according to rhythm and rate control strategy, anticoagulant and antiplatelet therapy, age, education, and comorbidities. Results Two hundred seventy‐two participants (25%) received rhythm control therapy, 331 (30.6%) rate control therapy, and 479 (44.3%) no therapy of interest. Four hundred thirty‐six (40.3%) in the total sample and in the different rhythm and rate control strategy groups were treated with an oral anticoagulant. Cognitive performance (mean SBT score) was found to be higher in the rhythm control group (7.5 ± 6.6) than in the no therapy (9.9 ± 7.9) and rate control (10.6 ± 8.3) (p<.001) groups. Logistic regression models adjusted for age, sex, education, anticoagulant and antiplatelet therapy, and comorbidities found that the rhythm control strategy (adjusted odds ratio (aOR)=0.56, 95% confidence interval (CI)=0.40–0.79, p=.001) and education (aOR 0.50, 95% CI=0.35–0.62; p<.001) were associated with less likelihood of cognitive impairment Conclusion In the absence of anticoagulation, rhythm control of AF may protect against cognitive decline. J Am Geriatr Soc 66:2178–2182, 2018.