Impact of cognitive impairment on clinical outcomes in elderly patients with atrial fibrillation: ANAFIE Registry

Ken Nagata; Hiroshi Inoue; Takeshi Yamashita; Masaharu Akao; Hirotsugu Atarashi; Takanori Ikeda; Yukihiro Koretsune; Ken Okumura; Wataru Shimizu; Shinya Suzuki; Hiroyuki Tsutsui; Kazunori Toyoda; Atsushi Hirayama; Takenori Yamaguchi; Satoshi Teramukai; Tetsuya Kimura; Yoshiyuki Morishima; Atsushi Takita; Masahiro Yasaka

doi:10.1136/bmjno-2022-000370

Impact of cognitive impairment on clinical outcomes in elderly patients with atrial fibrillation: ANAFIE Registry

BMJ Neurol Open. 2023 Jan 25;5(1):e000370. doi: 10.1136/bmjno-2022-000370. eCollection 2023.

Authors

Ken Nagata¹, Hiroshi Inoue², Takeshi Yamashita³, Masaharu Akao⁴, Hirotsugu Atarashi⁵, Takanori Ikeda⁶, Yukihiro Koretsune⁷, Ken Okumura⁸, Wataru Shimizu⁹, Shinya Suzuki³, Hiroyuki Tsutsui¹⁰, Kazunori Toyoda¹¹, Atsushi Hirayama¹², Takenori Yamaguchi¹¹, Satoshi Teramukai¹³, Tetsuya Kimura¹⁴, Yoshiyuki Morishima¹⁴, Atsushi Takita¹⁵, Masahiro Yasaka¹⁶

Affiliations

¹ Clinical Research Institute, Yokohama General Hospital, Yokohama, Japan.
² Saiseikai Toyama Hospital, Toyama, Japan.
³ The Cardiovascular Institute, Tokyo, Japan.
⁴ Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
⁵ AOI Hachioji Hospital, Tokyo, Japan.
⁶ Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
⁷ National Hospital Organization Osaka National Hospital, Osaka, Japan.
⁸ Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
⁹ Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
¹⁰ Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹¹ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
¹² Osaka Police Hospital, Osaka, Japan.
¹³ Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁴ Primary Medical Science Department, Daiichi Sankyo Co, Chuo-ku, Japan.
¹⁵ Data Intelligence Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan.
¹⁶ National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.

Abstract

Background: This subcohort study of All Nippon AF In the Elderly (ANAFIE) Registry based on 33 275 elderly patients (aged ≥75 years) with non-valvular atrial fibrillation (NVAF) investigated the relationship between cognitive function and 2-year clinical outcomes.

Methods: A total of 2963 (mean age, 81.4 years) patients participated in this subcohort study and were classified as having normal cognition (Mini-Mental State Examination (MMSE) score ≥24/30) or cognitive impairment (score ≤23/30) at baseline. Patients with a decrease of >2 points after 24 months were classified as having cognitive decline.

Results: At baseline, 586 (19.8%) patients had cognitive impairment. These patients tended to be older and had poorer general conditions than patients with normal cognition. The 2-year probability of stroke/systemic embolic events (SEEs), major bleeding and intracranial haemorrhage was numerically higher; those of cardiovascular death, all-cause death and net clinical outcome (composite of stroke/SEE, major bleeding and all-cause death) were significantly higher (all p<0.001) in patients with cognitive impairment versus normal cognition. In multivariate analysis, the risks of cardiovascular death (p=0.021), all-cause death (p<0.001) and net clinical outcome (p<0.001) were higher in patients with cognitive impairment versus those with normal cognition. After 24 months, 642 of 1915 (33.5%) patients with repeated MMSE determination had cognitive decline. Educational background <9 years, older age and concomitant cerebrovascular disorders were significant risk factors of cognitive decline at the 2-year follow-up.

Conclusions: Elderly patients with NVAF with cognitive impairment have a higher mortality risk than those with normal cognition. Several significant risk factors of cognitive decline were identified at 2-year follow-up.

Trial registration number: UMIN000024006 (http://www.umin.ac.jp/).

Keywords: CLINICAL NEUROLOGY; COGNITION.