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American Heart Journal

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Atrial fibrillation burden and cognitive decline in elderly patients undergoing continuous monitoring - 30/10/21

Doi : 10.1016/j.ahj.2021.08.006 
Mathias Pinto BONNESEN, MSc a, ⁎ , Søren Zöga DIEDERICHSEN, MD, PhD a, Jonas L. ISAKSEN, MSc b, Kristian Steen FREDERIKSEN, MD, PhD c, Steen Gregers HASSELBALCH, MD, DMSc c, d, Ketil Jørgen HAUGAN, MD, PhD e, Christian KRONBORG, PhD f, Claus GRAFF, PhD g, Søren HØJBERG, MD, PhD h, Lars KØBER, MD, DMSc a, d, Derk W. KRIEGER, MD, PhD i, j, Axel BRANDES, MD, DMSc k, l, m, Jesper Hastrup SVENDSEN, MD, DMSc a, d
a Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark 
b Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark 
c Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark 
d Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark 
e Department of Cardiology, Zealand University Hospital Roskilde, Roskilde Denmark 
f Department of Business and Economics, University of Southern Denmark, Odense, Denmark 
g Department of Health Science and Technology, Aalborg University, Aalborg, Denmark 
h Department of Cardiology, Copenhagen University Hospital Bispebjerg, Copenhagen Denmark 
i Department of Neurology, Mediclinic City Hospital, Dubai, United Arabic Emirates 
j Department of Neuroscience, Mohammed Bin Rashid University of Medicine and Health Science, Dubai, United Arabic Emirates 
k Department of Cardiology, Odense University Hospital, Odense, Denmark 
l Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark 
m Department of Internal Medicine – Cardiology, University Hospital of Southern Denmark – Esbjerg, Esbjerg, Denmark 

⁎Reprint requests: Mathias Pinto BONNESEN, MSc, Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, DenmarkDepartment of CardiologyCopenhagen University Hospital - RigshospitaletInge Lehmanns Vej 7Copenhagen2100Denmark

Riassunto

Aims

To study the relationship between subclinical atrial fibrillation (AF) and changes in cognitive function in a large cohort of individuals with stroke risk factors.

Methods

: Individuals with no prior AF diagnosis but with risk factors for stroke were recruited to undergo annual cognitive assessment with the Montreal Cognitive Assessment (MoCA) along with implantable loop recorder (ILR) monitoring for AF for 3 years. If AF episodes lasting ≥6 minutes were detected, oral anticoagulation (OAC) treatment was initiated.

Results

: A total of 1194 participants (55.2 % men, mean age 74.5 (±3.9)) had a combined duration of heart rhythm monitoring of ≈1.3 million days. Among these, 339 participants (28.3%) had adjudicated AF, with a median AF burden of 0.072% (0.02, 0.39), and 324 (96%) initiated OAC. When stratifying the participants into AF burden groups (No AF, AFlow (AF burden <0.25%), and AFhigh, (AF burden >0.25%)), only participants in the AFlow group had a decrease in MoCA score over time (P = .03), although this was not significant after adjustment for stroke risk factors. A subgroup analysis of 175 participants (14.6%) with a MoCA <26 at 3 years found no association to AF diagnosis or burden.

Conclusions

: In a high-risk population, subclinical AF detected by continuous monitoring and subsequently treated with OAC was not associated with a significant change in MoCA score over a 3-year period.

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© 2021  Pubblicato da Elsevier Masson SAS.
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P. 15-23 - Dicembre 2021 Ritorno al numero
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