Atrial Fibrillation: Possible Influences of Rate and Rhythm Control Strategy on Cognitive Performance

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Abstract

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.

Original languageEnglish
Pages (from-to)2178-2182
JournalJournal of the American Geriatrics Society
Volume66
Issue number11
DOIs
Publication statusPublished - 2018

Fingerprint

Atrial Fibrillation
Anticoagulants
Comorbidity
Therapeutics
Logistic Models
Odds Ratio
Confidence Intervals
Education
Control Groups
Sex Education
Internal Medicine
Geriatrics
Cognition
Databases
Cognitive Dysfunction

Keywords

  • atrial fibrillation
  • cognitive performance
  • rate and rhythm control strategy

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{8cd5887244334f239ecaed52c4fc9cc1,
title = "Atrial Fibrillation: Possible Influences of Rate and Rhythm Control Strategy on Cognitive Performance",
abstract = "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.",
keywords = "atrial fibrillation, cognitive performance, rate and rhythm control strategy",
author = "Sarah Damanti and Luca Pasina and Laura Cortesi and Rossi, {Paolo D.} and Matteo Cesari",
year = "2018",
doi = "10.1111/jgs.15568",
language = "English",
volume = "66",
pages = "2178--2182",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Blackwell Publishing Inc.",
number = "11",

}

TY - JOUR

T1 - Atrial Fibrillation

T2 - Possible Influences of Rate and Rhythm Control Strategy on Cognitive Performance

AU - Damanti, Sarah

AU - Pasina, Luca

AU - Cortesi, Laura

AU - Rossi, Paolo D.

AU - Cesari, Matteo

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

KW - atrial fibrillation

KW - cognitive performance

KW - rate and rhythm control strategy

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DO - 10.1111/jgs.15568

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JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

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