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Heart 99:542-547 doi:10.1136/heartjnl-2012-303182
  • Heart rhythm disorders
  • Original article

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

Editor's Choice
  1. on behalf of the SAFETY investigators
  1. 1National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease/Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
  2. 2Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Professor Simon Stewart, National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease/Preventative Health, Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road Central, Melbourne, VIC 8008, Australia; Simon.Stewart{at}bakeridi.edu.au
  • Received 9 October 2012
  • Revised 3 December 2012
  • Accepted 10 December 2012
  • Published Online First 12 January 2013

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 managmenT 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.

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