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Pino MD, Rivero P, Taylor A, Gabriel R. Impact of depression and cardiovascular risk factors on cognitive impairment in patients with atrial fibrillation: A Systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 128:105601. [PMID: 39213746 DOI: 10.1016/j.archger.2024.105601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/15/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common cardiac arrhythmia associated with significant cardiovascular morbidity and mortality, as well as cognitive impairment (CI). The interplay between AF and CI is complex, involving various pathophysiological changes and numerous risk factors. Among them, depression has emerged as a significant contributor to both AF and CI, further complicating the relationship between these conditions. OBJECTIVES This systematic review and meta-analysis aimed to investigate the influence of depression on the development of cognitive impairment in AF patients and assess the predictive value of the CHA2DS2-VASc score for CI risk. METHODS We searched PubMed, Scopus, and Web of Science for relevant studies without language or date restrictions. Ten studies, comprising 1,605,577 participants, were included. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics. Funnel plots and Egger's test evaluated publication bias. RESULTS Depression significantly increased the risk of CI in AF patients (OR: 2.23, 95 % CI: 1.54-3.21, p < 0.01; I2=99 %). This association persisted in studies excluding baseline CI (OR: 1.95, 95 % CI: 1.33-2.85, p < 0.01; I2=88 %). Subgroup analysis confirmed these results for both prospective (OR: 1.78, 95 % CI: 0.92-3.44, p = 0.02; I2=65 %) and retrospective studies (OR: 2.63, 95 % CI: 1.75-3.93, p < 0.01; I2=100 %). Analysis of CHA2DS2-VASc risk factors showed associations with CI, particularly cerebrovascular disease (OR: 1.86, 95 % CI: 1.61-2.16). CONCLUSIONS Our findings support the association between depression and cognitive impairment in AF patients, demonstrating the importance of addressing mental health in cardiovascular care. Future research is necessary for a comprehensive understanding of this association.
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Affiliation(s)
- Maria Del Pino
- Department of Biomedical Science and Public Health. Universidad Nacional de Educacion a Distancia (UNED), Madrid, Spain; Houston Methodist Hospital, TX, USA.
| | | | | | - Rafael Gabriel
- Department of International Health, National School of Health, Institute Carlos III, Spain
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Le Grande MR, Salvacion M, Shwaita L, Murphy BM, Jackson AC, Alvarenga ME. Does coping style mediate the relationship between knowledge and psychosocial outcomes in women with atrial fibrillation? Front Psychiatry 2024; 15:1328111. [PMID: 38585480 PMCID: PMC10995340 DOI: 10.3389/fpsyt.2024.1328111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction In patients affected by atrial fibrillation (AF) disease-specific knowledge and coping style may be associated with psychosocial well-being. This study aimed to determine if coping style (problem-focused, emotion-focused, avoidance-focused) mediated the relationship between patient knowledge and three psychosocial outcomes (anxiety, depression and life satisfaction). Methods In 2021 a total of 188 women with reported AF, and ages ranging from 18 to 83 years (mean 48.7, sd 15.5 years), completed an online questionnaire consisting of sociodemographic, clinical and AF knowledge questions and psychosocial instruments (Anxiety and depression, the Hospital Anxiety and Depression (HADS) scale; life satisfaction, Satisfaction With Life Scale (SWLS); and coping style (Brief COPE). Using Jamovi statistical software three individual mediational models (for anxiety, depression and life satisfaction) were constructed assessing the direct and indirect relationships between knowledge, coping style and each psychosocial outcome. Age was a covariate in each model. Results The mediation analyses demonstrated significant direct negative associations between AF knowledge and HADS anxiety and depression and positive associations with SWLS. There were also direct associations between each of the three coping styles and the three psychosocial outcomes. There were significant indirect effects of coping style between AF knowledge and each of the three outcomes confirming partial mediation effects. Discussion These findings highlight the crucial role of coping style in mediating the association between AF knowledge and psychosocial outcomes. As such, interventions aimed at increasing patient knowledge of AF may be more effective if adaptive problem-solving coping strategies are also demonstrated to these patients. Additionally, modification of maladaptive coping strategies as part of the psychological management of patients with AF is highly recommended.
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Affiliation(s)
- Michael R. Le Grande
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Marielle Salvacion
- Institute of Health and Wellbeing, Federation University, Berwick, VIC, Australia
| | - Lubab Shwaita
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Faculty of Science, Engineering and Built Environment, Deakin University, Burwood, VIC, Australia
| | - Barbara M. Murphy
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Alun C. Jackson
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
- Centre on Behavioral Health, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Marlies E. Alvarenga
- Australian Centre for Heart Health, Melbourne, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Berwick, VIC, Australia
- Victorian Heart Institute, Clayton, VIC, Australia
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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3
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Guan D, Lewis MO, Li P, Zhang Y, Zhang P, Tang S, Brown J, Guo J, Zhang Y, Shao H. Incremental burden on health-related quality of life, health service utilization and direct medical expenditures associated with cognitive impairment among non-institutionalized people with diabetes aged 65 years and older. Diabetes Obes Metab 2024; 26:275-282. [PMID: 37789596 DOI: 10.1111/dom.15313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
AIMS To quantify the incremental health and economic burden associated with cognitive impairment (CI) among non-institutionalized people with diabetes ≥65 years in the United States. MATERIALS AND METHODS Using 2016-2019 Medical Expenditure Panel Surveys data, we identified participants ≥65 years with diabetes. We used propensity score weighting to quantify the CI-associated incremental burden on health-related quality of life measured by the 12-item Short Form Survey (SF-12), including the mental component summary score, physical component summary score and health utility. We also compared the annual health service utilization and expenditures on ambulatory visits, prescriptions, home care, emergency room (ER), hospitalizations and total annual direct medical expenditures. RESULTS We included 5094 adults aged ≥65 with diabetes, of whom 804 had CI. After propensity score weighting, CI was associated with a lower mental component summary score (-8.4, p < .001), physical component summary score (-5.2, p < .001) and health utility (-0.12, p < .001). The CI group had more ambulatory visits (+4.4, p = .004) and prescriptions (+9.9, p < .001), with higher probabilities of having home care (+11.3%, p < .001) and ER visits (+8.2%, p = .001). People with CI spent $5441 (p < .001) more annually, $2039 (p = .002) more on prescriptions, $2695 (p < .001) more on home care and $118 (p < .001) more on ER visits. There is no statistically significant difference in the utilization and expenditure of hospitalizations. CONCLUSION CI was associated with worse health-related quality of life, higher health service utilization and expenditures. Our findings can be used to monitor the health and economic burden of CI in non-institutionalized older persons with diabetes.
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Affiliation(s)
- Dawei Guan
- Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Motomori O Lewis
- Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Piaopiao Li
- Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yichen Zhang
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Ping Zhang
- Division of Diabetes and Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shichao Tang
- Division of Diabetes and Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joshua Brown
- Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Jingchuan Guo
- Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
| | - Hui Shao
- Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Fomicheva AV, Troshina DV, Simonov AN, Kopylov PI, Andreev DA, Volel BA. [Impact of anxiety disorders on adherence to anticoagulant therapy in patients with atrial fibrillation]. TERAPEVT ARKH 2022; 94:1085-1093. [PMID: 36286760 DOI: 10.26442/00403660.2022.09.201891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
AIM To evaluate the impact of anxiety disorders on adherence to anticoagulant therapy (ACT) in patients with atrial fibrillation (AF). MATERIALS AND METHODS 179 outpatients (131 women, 48 men, mean age 69.96.2 years) with AF were examined. The research methods included a physical examination according to the standards of medical care in an outpatient facility, clinical and psychopathological examination using psychometric scales. RESULTS Based on the assessment of adherence to ACT using the MoriskyGreen test, 2 groups of patients were identified: Group 1 patients with high adherence to ACT, Group 2 patients with partial/low adherence to ACT. In group 1, anxiety disorders were verified in 51.7% of cases, in group 2 54.3%. There were no statistically significant differences in the prevalence and severity of anxiety in the study groups. In accordance with the binary logistic regression model, the probability of high adherence to therapy is determined by higher (compared with the group of patients with partial/low adherence to therapy) scores in terms of mental health (p0.001), vital activity (p=0.02) and the total score of the SF-36 scale (p=0.08), as well as the extraversion parameter (p=0.02) of the NEO-FFI scale. CONCLUSION In the present study, no significant association was found between anxiety symptoms and a decrease in adherence to ACT in patients with AF. However, the results obtained suggest a contribution to the adherence to therapy of personality characteristics.
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Affiliation(s)
- A V Fomicheva
- Sechenov First Moscow State Medical University (Sechenov University)
| | - D V Troshina
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - P I Kopylov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - D A Andreev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - B A Volel
- Sechenov First Moscow State Medical University (Sechenov University)
- Mental Health Research Center
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Bano A, Rodondi N, Beer JH, Moschovitis G, Kobza R, Aeschbacher S, Baretella O, Muka T, Stettler C, Franco OH, Conte G, Sticherling C, Zuern CS, Conen D, Kühne M, Osswald S, Roten L, Reichlin T. Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities: Insights From the Swiss-AF Study. J Am Heart Assoc 2021; 10:e021800. [PMID: 34753292 PMCID: PMC8751921 DOI: 10.1161/jaha.121.021800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Diabetes is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between patients who have AF with and without diabetes. This study investigated the association of diabetes with AF phenotype and cardiac and neurological comorbidities in patients with documented AF. Methods and Results Participants in the multicenter Swiss‐AF (Swiss Atrial Fibrillation) study with data on diabetes and AF phenotype were eligible. Primary outcomes were parameters of AF phenotype, including AF type, AF symptoms, and quality of life (assessed by the European Quality of Life‐5 Dimensions Questionnaire [EQ‐5D]). Secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, and heart failure) and neurological (ie, history of stroke and cognitive impairment) comorbidities. The cross‐sectional association of diabetes with these outcomes was assessed using logistic and linear regression, adjusted for age, sex, and cardiovascular risk factors. We included 2411 patients with AF (27.4% women; median age, 73.6 years). Diabetes was not associated with nonparoxysmal AF (odds ratio [OR], 1.01; 95% CI, 0.81–1.27). Patients with diabetes less often perceived AF symptoms (OR, 0.74; 95% CI, 0.59–0.92) but had worse quality of life (β=−4.54; 95% CI, −6.40 to −2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac (hypertension [OR, 3.04; 95% CI, 2.19–4.22], myocardial infarction [OR, 1.55; 95% CI, 1.18–2.03], heart failure [OR, 1.99; 95% CI, 1.57–2.51]) and neurological (stroke [OR, 1.39, 95% CI, 1.03–1.87], cognitive impairment [OR, 1.75, 95% CI, 1.39–2.21]) comorbidities. Conclusions Patients who have AF with diabetes less often perceive AF symptoms but have worse quality of life and more cardiac and neurological comorbidities than those without diabetes. This raises the question of whether patients with diabetes should be systematically screened for silent AF. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02105844.
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Affiliation(s)
- Arjola Bano
- Department of Cardiology InselspitalBern University HospitalUniversity of Bern Switzerland.,Institute of Social and Preventive Medicine (ISPM) University of Bern Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine InselspitalBern University HospitalUniversity of Bern Switzerland.,Institute of Primary Health Care (BIHAM) University of Bern Switzerland
| | - Jürg H Beer
- Department of Medicine Cantonal Hospital of Baden and Molecular CardiologyUniversity Hospital of Zürich Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology Regional Hospital of LuganoEnte Ospedaliero Cantonale (EOC) Lugano Switzerland
| | - Richard Kobza
- Department of Cardiology Luzerner Kantonsspital Luzern Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of Basel Switzerland.,Cardiology Division University Hospital BaselUniversity of Basel Switzerland
| | - Oliver Baretella
- Department of General Internal Medicine InselspitalBern University HospitalUniversity of Bern Switzerland.,Institute of Primary Health Care (BIHAM) University of Bern Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM) University of Bern Switzerland
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism InselspitalBern University HospitalUniversity of Bern Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM) University of Bern Switzerland
| | - Giulio Conte
- Division of Cardiology Cardiocentro Ticino Lugano Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of Basel Switzerland.,Cardiology Division University Hospital BaselUniversity of Basel Switzerland
| | - Christine S Zuern
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of Basel Switzerland.,Cardiology Division University Hospital BaselUniversity of Basel Switzerland
| | - David Conen
- Population Health Research InstituteMcMaster University Hamilton Ontario Canada
| | - Michael Kühne
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of Basel Switzerland.,Cardiology Division University Hospital BaselUniversity of Basel Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute BaselUniversity Hospital BaselUniversity of Basel Switzerland.,Cardiology Division University Hospital BaselUniversity of Basel Switzerland
| | - Laurent Roten
- Department of Cardiology InselspitalBern University HospitalUniversity of Bern Switzerland
| | - Tobias Reichlin
- Department of Cardiology InselspitalBern University HospitalUniversity of Bern Switzerland
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Safarudin F, Iloabuchi CO, Ladani A, Sambamoorthi U. The Association of Beta-Blocker Use to Cognitive Impairment among Adults with Hypertension or Cardiovascular Diseases in the United States. CHRONIC PAIN & MANAGEMENT 2020; 4:125. [PMID: 32661512 PMCID: PMC7357995 DOI: 10.29011/2576-957x.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Some studies have shown that beta-blocker use is associated with better cognitive impairment. However, these studies did not control for pain. The relationship between pain and cognitive impairment has been exhaustively investigated. The association of beta blockers to cognitive impairment in the presence of chronic pain is still unknown. OBJECTIVE To examine the independent association of beta-blocker use to cognitive impairment among adults with hypertension or Cardiovascular Diseases (CVDs). METHODS We used a cross-sectional study design. We derived data on 8,279 adults from the 2015 Medical Expenditure Panel Survey (MEPS). Study participants were adults (age > 21 years), with hypertension or CVDs and without intracranial injury, Parkinson, Alzheimer's disease and Related Dementia. Cognitive impairment was measured based on 1) confusion or memory loss; 2) problems making decisions, or 3) supervision for participant's safety. Anti-hypertensive medications were categorized into 1) beta-blockers; 2) other anti-hypertensives; and 3) no antihypertensive medication. We used multivariable survey logistic regressions to examine the association between beta-blockers and cognitive impairment after controlling for biological factors, pain, chronic conditions, socioeconomic status, access to healthcare services, behavioral, socio-cultural and external environmental factors. RESULTS Overall, 24.2%, 41.9%, and 33.9% reported using beta-blockers, other antihypertensives, and no antihypertensive medications, respectively; 18.1% participants reported cognitive impairment. After controlling for pain, beta-blocker use was not significantly associated with cognitive impairment (AOR= 1.22, 95%CI= 1.00-1.49). In fully adjusted models, the AOR for beta-blockers use was 1.05 (95%CI = 0.84-1.31). CONCLUSION In this first large cross-sectional study, we found that the use of beta-blockers was not associated with cognitive impairment. Future prospective studies that include pain management and blood pressure control are needed to confirm the findings.
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Affiliation(s)
- Fnu Safarudin
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, USA
- School of Mathematics and Natural Sciences, Tadulako University, Indonesia
| | - Chibuzo O Iloabuchi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, USA
| | - Amit Ladani
- Department of Medicine, Section of Rheumatology, West Virginia University School of Pharmacy, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, USA
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Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study. Arch Gerontol Geriatr 2020; 90:104117. [PMID: 32474170 PMCID: PMC7434686 DOI: 10.1016/j.archger.2020.104117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 11/25/2022]
Abstract
Background: Depression, anxiety, and cognitive impairments occur in up to 40 % of adults with AF and are associated with poorer health-related quality of life (HRQoL) and higher symptom burden. However, it is unknown how often these impairments co-occur, or multimorbidity, and how multimorbidity effects HRQoL and symptom burden. Methods: Patients with AF age ≥65 years with a CHA2DS2VASC risk score ≥ 2 and eligible for oral anticoagulation therapy were recruited from five clinics in a prospective cohort study. Participants completed validated measures of depression (PHQ9) and anxiety (GAD7), cognitive impairment (MoCA), and HRQOL and AF symptom burden (AFEQT). Multinomial logistic regression was used. Results: Participants (N = 1244, 49 % female) were on average 76 ± 7 years; 86 % were non-Hispanic white. Approximately 35 % of participants had 1 impairment, 17 % had 2 impairments and 8% had 3 impairments; 39 % had none of the 3 impairments examined. Compared to participants with no impairments, patients with 1, 2 and 3 impairments had higher odds of poor HRQoL (adjusted OR [AOR] = 1.77, 95 % CI 1.21, 2.60; AOR = 6.64, 95 % CI 4.43, 9.96; and AOR = 7.50, 95 % CI 4.40, 12.77, respectively) and those with 2 and 3 impairments had higher odds of high symptom burden (AOR = 3.69 95 % CI 2.22, 6.13; and AOR = 5.41 95 % CI 2.85, 10.26). Conclusions: Psychosocial/cognitive multimorbidity is common among older adults with AF and is associated with poor HRQoL and high symptom burden. Clinicians might consider incorporating psychosocial and cognitive screens into routine care as this may identify a high-risk population.
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Prevalence and Progression of Cognitive Impairment in Atrial Fibrillation Patients after Treatment with Catheter Ablation or Drug Therapy. Cardiol Res Pract 2019; 2019:7216598. [PMID: 31915546 PMCID: PMC6931025 DOI: 10.1155/2019/7216598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 11/17/2019] [Accepted: 11/23/2019] [Indexed: 01/28/2023] Open
Abstract
Purpose In atrial fibrillation (AF) patients, the effect of catheter ablation or drug therapy on cognition is currently not well investigated. Therefore, we prospectively evaluated AF patients who were either treated 'with drug therapy or underwent catheter ablation for the prevalence and progression of cognitive impairment (CI). Methods Randomized participants of the CABANA trial (catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation) and the CASTLE-AF (catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation) study were assessed twice within 6 months by Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in our institution. Results Forty-five patients from both trials were investigated, and twenty-eight patients received catheter ablation, whereas seventeen patients received drug therapy for rhythm or rate control. The mean age of the twenty-one CABANA trial patients (AF group) was 68.8 ± 7.0 years and of the twenty-four CASTLE-AF study patients (AF/HF group) was 66.8 ± 8.1 years, respectively. Mean time from ablation/randomization to the first interview was 16.8 ± 11 months in the AF group and 28.3 ± 18.4 months in the AF/HF group, respectively. All patients investigated were classified as cognitively impaired with mean cutoff scores <24 by MoCA. Overall, we could not detect significant differences in medically treated versus catheter ablation patients within both groups in mean MMSE or MoCA scores between the first and the second interview (p > 0.09). Moreover, patients who received catheter ablation did not show statistically significant differences in the prevalence or progression of cognitive impairment compared to patients who were treated medically, neither within the two groups nor between AF and AF/HF patients (p > 0.05). Conclusions Prevalence of cognitive impairment in AF patients with comorbidities is substantial. However, in this preliminary prospective study, no apparent impact of AF pretreatment on the prevalence and course of cognitive impairment could be observed.
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Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152698. [PMID: 31362337 PMCID: PMC6696263 DOI: 10.3390/ijerph16152698] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 12/17/2022]
Abstract
Atrial Fibrillation (AF) patients could reduce their risk of stroke by using oral antithrombotic therapy. However, many older people with AF experience cognitive impairment and have limited health literacy, which can lead to non-adherence to antithrombotic treatment. This study aimed to investigate the influence of cognitive impairment and health literacy on non-adherence to antithrombotic therapy. The study performed a secondary analysis of baseline data from a cross-sectional survey of AF patients’ self-care behaviors at a tertiary university hospital in 2018. Data were collected from a total of 277 AF patients aged 65 years and older, through self-reported questionnaires administered by face-to-face interviews. Approximately 50.2% of patients were non-adherent to antithrombotic therapy. Multiple logistic regression analysis revealed that cognitive impairment independently increased the risk of non-adherence to antithrombotic therapy (odds ratio = 2.628, 95% confidence interval = 1.424–4.848) after adjustment for confounding factors. However, health literacy was not associated with non-adherence to antithrombotic therapy. Cognitive impairment is a significant risk factor for poor adherence to antithrombotic therapy. Thus, health professionals should periodically assess both cognitive function after AF diagnosis and adherence to medication in older patients. Further studies are needed to identify the factors that affect cognitive decline and non-adherence among AF patients.
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10
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Zheng Q, Di Biase L, Ferrick KJ, Gross JN, Guttenplan NA, Kim SG, Krumerman AK, Palma EC, Fisher JD. Use of antimicrobial agent pocket irrigation for cardiovascular implantable electronic device infection prophylaxis: Results from an international survey. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1298-1306. [DOI: 10.1111/pace.13473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Qi Zheng
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Luigi Di Biase
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Kevin J. Ferrick
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Jay N. Gross
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Nils A. Guttenplan
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Soo G. Kim
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Andrew K. Krumerman
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Eugen C. Palma
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - John D. Fisher
- Arrhythmia Service, Cardiology Division, Department of Medicine, Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
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11
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Anxiety and Depression in Patients with Permanent Atrial Fibrillation: Prevalence and Associated Factors. Cardiol Res Pract 2018; 2018:7408129. [PMID: 29670767 PMCID: PMC5836417 DOI: 10.1155/2018/7408129] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/11/2018] [Indexed: 01/27/2023] Open
Abstract
Atrial fibrillation (AF) is an important public health problem that is increasing at an alarming rate, worldwide. The most common type is permanent AF followed by the paroxysmal and persistent AF. Purpose. This study was aimed at exploring anxiety and depression and the associated factors in patients with permanent AF. Materials and Methods. The sample of the study included 170 AF patients. Data collection was performed by the method of interview using the "Hospital Anxiety and Depression Scale" (HADS) to assess anxiety and depression and a questionnaire including patients' characteristics. Results. 70% of the participants were men, and 32.4% were above 70 years old. Furthermore, 34.9% of the patients had high levels of anxiety, and 20.2% had high levels of depression. Anxiety levels were statistically significantly associated with gender (p=0.022), age (p=0.022), educational level (p=0.025), years having the disease (p=0.005), and relations with nursing staff (p=0.040). Depression levels were statistically significantly associated with age (p=0.037), degree of information of the state of health (p < 0.001), years having the disease (p < 0.001), and relations with medical staff (p=0.041). Conclusions. Patients' characteristics are associated with anxiety and depression and need to be evaluated when treating this frequently encountered arrhythmia.
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Ball J, Løchen ML, Carrington MJ, Wiley JF, Stewart S. Mild cognitive impairment impacts health outcomes of patients with atrial fibrillation undergoing a disease management intervention. Open Heart 2018. [PMID: 29531768 PMCID: PMC5845397 DOI: 10.1136/openhrt-2017-000755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Mild cognitive impairment (MCI) is prevalent in atrial fibrillation (AF) and has the potential to contribute to poor outcomes. We investigated the influence of MCI on survival and rehospitalisation in patients with chronic forms of AF undergoing a home-based, AF-specific disease management intervention (home-based intervention (HBI)) or standard management (SM). Methods The Montreal Cognitive Assessment tool was administered at baseline (a score of <26/30 indicated MCI) in patients with AF randomised to HBI versus SM. Post hoc analyses of mortality and rehospitalisations during a minimum 24-month follow-up were conducted in the overall cohort and in each study group separately. Results Of 260 patients (mean age 72±11, 47% female), 65% demonstrated MCI on screening (34% in SM; 31% in HBI). Overall, the number of days spent alive and out-of-hospital during follow-up (P=0.012) and all-cause rehospitalisation were influenced by MCI during follow-up (OR 3.16 (95% CI 1.46 to 6.84)) but MCI did not influence any outcomes in the SM group. However, survival was negatively influenced by MCI in the HBI group (P=0.036); those with MCI in this group were 5.6 times more likely to die during follow-up (OR 5.57 (95% CI 1.10 to 28.1)). Those with MCI in the HBI group also spent less days alive and out-of-hospital than those with no MCI (P=0.022). MCI was also identified as a significant independent correlate of shortest duration of event-free survival (OR 3.48 (95% CI 1.06 to 11.4)), all-cause rehospitalisation (OR 3.30 (95% CI 1.25 to 8.69)) and cardiovascular disease (CVD)-related rehospitalisation (OR 2.35 (95% CI 1.12 to 4.91)) in this group. Conclusions The effectiveness of home-based, disease management for patients with chronic forms of AF is negatively affected by comorbid MCI. The benefit of adjunctive support for patients with MCI on CVD-related health outcomes requires further investigation.
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Affiliation(s)
- Jocasta Ball
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maja-Lisa Løchen
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
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McCabe PJ, Stuart-Mullen LG, McLeod CJ, O Byrne T, Schmidt MM, Branda ME, Griffin JM. Patient activation for self-management is associated with health status in patients with atrial fibrillation. Patient Prefer Adherence 2018; 12:1907-1916. [PMID: 30288031 PMCID: PMC6161745 DOI: 10.2147/ppa.s172970] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Higher levels of patient activation for self-managing health are associated with positive clinical and health care utilization outcomes. Identifying a patient's activation level can guide clinicians to tailor interventions to improve their health. Effective self-management of atrial fibrillation (AF) requires patient activation to participate in treatment decisions, prevent complications, and manage risk factors. Yet, little is known about activation in patients with AF. The purpose of this descriptive study was to identify patient activation levels and factors associated with activation in patients with AF. METHODS Patients (N=123), 66% male, with a mean (SD) age of 59.9 (11.3) years seeking treatment for AF at an arrhythmia clinic completed the Patient Activation Measure (PAM), Atrial Fibrillation Severity Scale, Knowledge about Atrial Fibrillation test, Hospital Anxiety Depression Scale, Godin Leisure-Time Exercise Questionnaire, and Patient Assessment of Chronic Illness Care. Sociodemographic and clinical data were obtained from medical records. PAM scores were categorized into Levels 1-4. Associations among patient-reported outcomes, sociodemographic, and clinical variables were analyzed using Fisher's exact tests and Kruskal-Wallis procedures. RESULTS The PAM scores of nearly half (45.5%) of the patients were at Level 3, while the scores of 38% were at Level 4. Male sex (P=0.02), higher education (P=0.004), being employed (P=0.005), lower body mass index (P=0.03), tobacco abstinence (P=0.02), less AF symptom burden (P=0.006), less depression (P≤0.0001) and anxiety (P=0.006), greater knowledge of AF (P=0.01), and higher levels of physical activity (P=0.02) were associated with higher activation levels. CONCLUSION Higher levels of patient activation in those with AF were associated with a more positive health status and educational attainment. Additional research to describe activation in patients with AF is warranted to identify patients at risk for low activation and to tailor interventions to activation level.
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Affiliation(s)
- Pamela J McCabe
- Mayo Clinic Department of Nursing, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA,
| | - Lynette G Stuart-Mullen
- Mayo Clinic Department of Nursing, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA,
| | - Christopher J McLeod
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Thomas O Byrne
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Monika M Schmidt
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Megan E Branda
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
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Maaroos M, Pohjantähti-Maaroos H, Halonen J, Vähämetsä J, Turtiainen J, Rantonen J, Hakala T, Mennander AA, Hartikainen J. New onset postoperative atrial fibrillation and early anticoagulation after cardiac surgery. SCAND CARDIOVASC J 2017; 51:323-326. [DOI: 10.1080/14017431.2017.1385836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Martin Maaroos
- Heart Centre Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | | | - Jari Halonen
- Heart Centre Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Juha Vähämetsä
- Heart Centre Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | | | - Juha Rantonen
- Department of Cardiology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Tapio Hakala
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
| | - Ari A. Mennander
- Tampere University Heart Hospital and Tampere University, Tampere, Finland
| | - Juha Hartikainen
- Heart Centre Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
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Symptoms and Quality of Life After Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2017; 3:1177-1179. [DOI: 10.1016/j.jacep.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/07/2017] [Indexed: 11/18/2022]
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