Department of Cardiology, Mayo Clinic, Rochester, MN.
Duke Clinical Research Institute, Durham, NC.
Am Heart J. 2019 May;211:77-89. doi: 10.1016/j.ahj.2019.01.005. Epub 2019 Jan 30.
The incidence of cognitive impairment and frailty increase with age and may impact both therapy and outcomes in atrial fibrillation (AF).
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.
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.
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.
认知障碍和衰弱的发病率随着年龄的增长而增加，可能会影响心房颤动（AF）的治疗和结局。
我们在 Outcomes Registry for Better Informed Care in AF（ORBIT AF）中检查了临床认知障碍和衰弱（根据美国老年学会标准定义）的患病率，并通过多变量 Cox 回归分析了相关调整后的结局。还检查了认知障碍和衰弱与口服抗凝剂（OAC）在确定结局方面的相互作用。
在 9749 例 AF 患者中[中位数（IQR）年龄 75（67-82）岁，57%为男性]，分别有 293 例（3.0%）和 575 例（5.9%）患者存在认知障碍和衰弱。衰弱患者（68% vs 77%，P <.001）和认知障碍患者（70% vs 77%，P =.006）更不可能接受 OAC。认知障碍[HR（95%CI）1.34（1.05-1.72），P =.0198]和衰弱[HR 1.29（1.08-1.55），P =.0060]均与死亡风险增加相关。认知障碍和衰弱与卒中和短暂性脑缺血发作（TIA）或大出血无关。在多变量分析中，OAC 使用与认知障碍或衰弱之间没有相互作用，这与死亡率、大出血以及卒中和非中枢神经系统全身性栓塞、TIA、心肌梗死或心血管死亡的复合终点无关。
AF 中存在认知障碍或衰弱的患者发生中风的预测风险更高，观察到的死亡率更高，但接受 OAC 治疗的可能性更低。尽管如此，OAC 在认知障碍或衰弱患者中的获益与无认知障碍或衰弱患者相似。
