Malini Madhavan1, DaJuanicia N Holmes2, Jonathan P Piccini2, Jack E Ansell3, Gregg C Fonarow4, Elaine M Hylek5, Peter R Kowey6, Kenneth W Mahaffey7, Laine Thomas2, Eric D Peterson2, Paul Chan8, Larry A Allen9, Bernard J Gersh10. 1. Department of Cardiology, Mayo Clinic, Rochester, MN. Electronic address: Madhavan.malini@mayo.edu. 2. Duke Clinical Research Institute, Durham, NC. 3. New York University School of Medicine, Lenox Hill Hospital, New York. 4. University of California, Los Angeles, CA. 5. Boston University School of Medicine, Boston, MA. 6. Lankenau Heart Institute and the Jefferson Medical College, Philadelphia, PA. 7. Stanford University School of Medicine, Palo Alto, CA. 8. University of Missouri-Kansas City School of Medicine, Kansas City, MO. 9. University of Colorado School of Medicine, Aurora, CO. 10. Department of Cardiology, Mayo Clinic, Rochester, MN.
Abstract
BACKGROUND: The incidence of cognitive impairment and frailty increase with age and may impact both therapy and outcomes in atrial fibrillation (AF). METHODS: We examined the prevalence of clinically recognized cognitive impairment and frailty (as defined by the American Geriatric Society Criteria) in the Outcomes Registry for Better Informed Care in AF (ORBIT AF) and associated adjusted outcomes via multivariable Cox regression. The interaction between cognitive impairment and frailty and oral anticoagulation (OAC) in determining outcomes was examined. RESULTS: Among 9749 patients with AF [median (IQR) age 75 (67-82) y, 57% male], cognitive impairment and frailty was identified in 293 (3.0%) and 575 (5.9%) patients respectively. Frail patients (68 vs 77%, P < .001) and those with cognitive impairment (70 vs 77%, P = .006) were both less likely to receive an OAC. Both cognitive impairment [HR (95% CI) 1.34 (1.05-1.72), P = .0198] and frailty [HR 1.29 (1.08-1.55), P = .0060] were associated with increased risk of death. Cognitive impairment and frailty were not associated with stroke/transient ischemic attack (TIA) or major bleeding. In multivariable analysis, there was no interaction between OAC use and cognitive impairment or frailty in their associations with mortality, major bleeding and a composite end point of stroke, non-central nervous system systemic embolism, TIA, myocardial infarction or cardiovascular death. CONCLUSION: Those with cognitive impairment or frailty in AF had higher predicted risk for stroke and higher observed mortality, yet were less likely to be treated with OAC. Despite this, the benefits of OAC were similar in patients with and without cognitive impairment or frailty.
BACKGROUND: The incidence of cognitive impairment and frailty increase with age and may impact both therapy and outcomes in atrial fibrillation (AF). METHODS: We examined the prevalence of clinically recognized cognitive impairment and frailty (as defined by the American Geriatric Society Criteria) in the Outcomes Registry for Better Informed Care in AF (ORBIT AF) and associated adjusted outcomes via multivariable Cox regression. The interaction between cognitive impairment and frailty and oral anticoagulation (OAC) in determining outcomes was examined. RESULTS: Among 9749 patients with AF [median (IQR) age 75 (67-82) y, 57% male], cognitive impairment and frailty was identified in 293 (3.0%) and 575 (5.9%) patients respectively. Frail patients (68 vs 77%, P < .001) and those with cognitive impairment (70 vs 77%, P = .006) were both less likely to receive an OAC. Both cognitive impairment [HR (95% CI) 1.34 (1.05-1.72), P = .0198] and frailty [HR 1.29 (1.08-1.55), P = .0060] were associated with increased risk of death. Cognitive impairment and frailty were not associated with stroke/transient ischemic attack (TIA) or major bleeding. In multivariable analysis, there was no interaction between OAC use and cognitive impairment or frailty in their associations with mortality, major bleeding and a composite end point of stroke, non-central nervous system systemic embolism, TIA, myocardial infarction or cardiovascular death. CONCLUSION: Those with cognitive impairment or frailty in AF had higher predicted risk for stroke and higher observed mortality, yet were less likely to be treated with OAC. Despite this, the benefits of OAC were similar in patients with and without cognitive impairment or frailty.
Authors: Jane S Saczynski; Saket R Sanghai; Catarina I Kiefe; Darleen Lessard; Francesca Marino; Molly E Waring; David Parish; Robert Helm; Felix Sogade; Robert Goldberg; Jerry Gurwitz; Weijia Wang; Tanya Mailhot; Benita Bamgbade; Bruce Barton; David D McManus Journal: J Am Geriatr Soc Date: 2019-10-01 Impact factor: 5.562
Authors: Oriol Yuguero; Irene Cabello; María Arranz; Jorge-Alexis Guzman; Anna Moreno; Paloma Frances; Julia Santos; Anna Esquerrà; Alvaro Zarauza; Josep-Maria Mòdol; Javier Jacob Journal: Intern Emerg Med Date: 2021-10-22 Impact factor: 3.397
Authors: Jordy Mehawej; Jane S Saczynski; Catarina I Kiefe; Hawa O Abu; Mayra Tisminetzky; Weijia Wang; Benita A Bamgbade; Eric Ding; Darleen Lessard; Edith Mensah Otabil; Connor Saleeba; Robert J Goldberg; David D McManus Journal: J Clin Sleep Med Date: 2022-02-01 Impact factor: 4.324
Authors: Igor Diemberger; Stefano Fumagalli; Anna Maria Mazzone; Ameet Bakhai; Paul Egbert Reimitz; Ladislav Pecen; Marius Constantin Manu; José Antonio Gordillo de Souza; Paulus Kirchhof; Raffaele De Caterina Journal: Europace Date: 2022-10-13 Impact factor: 5.486
Authors: Agnieszka Kotalczyk; Michał Mazurek; Zbigniew Kalarus; Tatjana S Potpara; Gregory Y H Lip Journal: Nat Rev Cardiol Date: 2020-10-27 Impact factor: 32.419
Authors: Saket R Sanghai; Weisong Liu; Weijia Wang; Subendhu Rongali; Ariela R Orkaby; Jane S Saczynski; Adam J Rose; Alok Kapoor; Wenjun Li; Hong Yu; David D McManus Journal: J Gen Intern Med Date: 2021-05-04 Impact factor: 5.128
Authors: Sachin J Shah; Margaret C Fang; Sun Y Jeon; Steven E Gregorich; Kenneth E Covinsky Journal: J Am Geriatr Soc Date: 2020-09-28 Impact factor: 5.562
Authors: Joris R de Groot; Thomas W Weiss; Peter Kelly; Pedro Monteiro; Jean Claude Deharo; Carlo de Asmundis; Esteban López-de-Sá; Johannes Waltenberger; Jan Steffel; Pierre Levy; Ameet Bakhai; Wolfgang Zierhut; Petra Laeis; Marius Constantin Manu; Paul-Egbert Reimitz; Raffaele De Caterina; Paulus Kirchhof Journal: Eur Heart J Cardiovasc Pharmacother Date: 2021-04-09