Atrial fibrillation and the risk of incident dementia: A meta-analysis
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.Heart rhythm: the official journal of the Heart Rhythm Society (Impact Factor: 5.08). 08/2012; 9(11). DOI: 10.1016/j.hrthm.2012.07.026
BACKGROUND: The risk of cerebrovascular embolic events with atrial fibrillation (AF) is potentially linked to an increased risk of cognitive decline and dementia. However, epidemiologic studies exploring the association between AF and incident dementia have reported conflicting results. OBJECTIVE: The purpose of this study was to perform a meta-analysis of observational studies specifically designed to evaluate the prospective relationship between AF and incident dementia. METHODS: We searched PubMed, CENTRAL, BioMedCentral, Embase, Cardiosource, clinicaltrials.gov, and ISI Web of Science (January 1980 to May 2012). No language restriction was applied. Two independent reviewers screened titles and abstracts to identify population-based studies that prospectively evaluated the association between AF and the incidence of dementia in patients not suffering an acute stroke and with normal cognitive function at baseline, providing the hazard ratio (HR) obtained in multiple Cox regression analyses, and adjusted for all confounding variables. Two independent reviewers assessed risk of bias according to the Cochrane Collaboration, and extracted patient and study characteristics and the adjusted HR of incident dementia with its 95% confidence interval (CI) of patients with AF vs those without AF. RESULTS: Eight studies with 77,668 patients were included in the analysis. All studies had a prospective observational design and included elderly patients (mean age range 61-84 years) with normal cognitive function at baseline, of whom 11,700 (15%) had AF. After a mean follow-up of 7.7 ± 9.1 years (range 1.8-30 years), 4773 of 73,321 (6.5%) patients developed dementia. Two studies did not report the rates of dementia at follow-up but reported the adjusted HR and were included in the pooled analysis. At pooled analysis adjusted for baseline confounders and covariates, AF was independently associated with increased risk of incident dementia (HR = 1.42 [95% CI 1.17-1.72], P <.001). CONCLUSION: AF is independently associated with increased risk of dementia. Patients with AF should be periodically screened for dementia, which should be included among the outcomes assessed in AF treatment trials.
Article: Has the dream come through?Journal of electrocardiology 01/2013; 46(1):36-7. DOI:10.1016/j.jelectrocard.2012.11.003 · 1.36 Impact Factor
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ABSTRACT: To compare the prevalence of silent cerebral ischemia (SCI) and cognitive performance in paroxysmal and persistent atrial fibrillation (AF) patients and controls in Sinus Rhythm (SR). Large registries reported a similar risk for symptomatic stroke in both paroxysmal and persistent AF. The relationship between paroxysmal and persistent AF, SCI and cognitive impairment has remained uncharted. Two hundred-seventy subjects were enrolled: 180 patients with AF (50% paroxysmal and 50% persistent) and 90 controls. All subjects received clinical assessment, neurological examination, cerebral magnetic resonance (MR) and underwent the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). At least one SCI was present in 80 (89%) patients with paroxysmal, 83 (92%) with persistent AF (paroxysmal vs persistent; p=0.59) and in 41 (46%) controls (paroxysmal vs controls and persistent vs controls; p<0.01). Number of SCI per person was higher in persistent than in paroxysmal AF patients (41.1±28.0 vs 33.2 ±22.8; p=0.04), with controls reporting lower figures (12.0±26.7; both p<0.01). Cognitive performance was significantly worse in persistent and paroxysmal AF patients than in controls (RBANS 82.9±11.5, 86.2±13.8 and 92.4±15.4 points respectively; p<0.01). Paroxysmal and persistent AF patients presented a higher prevalence and number of SCI per patient than controls and confirmed a worse cognitive performance than subjects in SR.Journal of the American College of Cardiology 06/2013; 62(21). DOI:10.1016/j.jacc.2013.05.074 · 16.50 Impact Factor
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ABSTRACT: The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to detect AF. Most clinical management decisions in AF patients can be based on validated parameters that encompass type of presentation, clinical factors, electrocardiogram analysis, and cardiac imaging. Despite these advances, patients with AF are still at increased risk for death, stroke, heart failure, and hospitalizations. During the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association (AFNET/EHRA) consensus conference, we identified the following opportunities to personalize management of AF in a better manner with a view to improve outcomes by integrating atrial morphology and damage, brain imaging, information on genetic predisposition, systemic or local inflammation, and markers for cardiac strain. Each of these promising avenues requires validation in the context of existing risk factors in patients. More importantly, a new taxonomy of AF may be needed based on the pathophysiological type of AF to allow personalized management of AF to come to full fruition. Continued translational research efforts are needed to personalize management of this prevalent disease in a better manner. All the efforts are expected to improve the management of patients with AF based on personalized therapy.Europace 08/2013; 15(11). DOI:10.1093/europace/eut232 · 3.67 Impact Factor
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