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, St Kilda Road Central, Melbourne, VIC 8008, Australia.
Heart. 2013 Apr;99(8):542-7. doi: 10.1136/heartjnl-2012-303182. Epub 2013 Jan 12.
We examined cognitive function in older hospitalised patients with chronic atrial fibrillation (AF).
A prospective substudy of a multicentre randomised trial of an AF-specific disease management intervention (the Standard versus Atrial Fibrillation spEcific managemenT studY; SAFETY).
Three tertiary referral hospitals within Australia.
A total of 260 patients with chronic AF: mean age 72±11 years, 53% men, mean CHA2DS2-VASc score 4±2.
Cognitive function was assessed at baseline (during inpatient stay) using the Montreal Cognitive Assessment (MoCA).
The extent of mild cognitive impairment (MCI-defined as a MoCA score <26) in AF patients and identification of independent predictors of MCI.
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).
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.
我们研究了慢性心房颤动（AF）住院老年患者的认知功能。
对特定于 AF 的疾病管理干预（标准与心房颤动特定管理研究；SAFETY）多中心随机试验的前瞻性亚研究。
澳大利亚的三家三级转诊医院。
共 260 例慢性 AF 患者：平均年龄 72±11 岁，53%为男性，平均 CHA2DS2-VASc 评分 4±2。
在基线（住院期间）使用蒙特利尔认知评估（MoCA）评估认知功能。
AF 患者轻度认知障碍（MCI，定义为 MoCA 评分<26）的程度以及识别 MCI 的独立预测因素。
总体而言，260 例患者中有 169 例（65%，95%CI 59%至 71%）在基线时存在 MCI（平均 MoCA 评分 21±3）。确定了认知域的多种缺陷，最明显的是执行功能、视觉空间能力和短期记忆。MCI 的预测因素（年龄和性别调整）为较低的教育水平（技术/贸易学校水平 OR 6.00，95%CI 2.07 至 17.42；<8 年学校教育 OR 5.29，95%CI 1.95 至 14.36 与 8-13 年），较高的 CHA2DS2-VASc 评分（OR 1.46，95%CI 1.23 至 1.74）和处方地高辛（OR 2.19，95%CI 1.17 至 4.10）。
MCI 在因 AF 住院的典型高龄高危患者中高度普遍。对于该患者群体，建议常规评估认知功能并调整临床管理。
