Mild cognitive impairment in high-risk patients with chronic atrial fibrillation: a forgotten component of clinical management?
- Jocasta Ball1,2,
- Melinda Jane Carrington1,2,
- Simon Stewart1,2,
- on behalf of the SAFETY investigators
- 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
- 2Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- 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;
- Received 9 October 2012
- Revised 3 December 2012
- Accepted 10 December 2012
- Published Online First 12 January 2013
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.