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Frailty, cognitive impairment in AF increase death odds
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Patients with atrial fibrillation who had cognitive impairment or frailty had elevated risk for mortality, according to findings published in the American Heart Journal.
The researchers found there were similar benefits of anticoagulants in patients with or without cognitive impairment or frailty, but those with either condition were less likely to receive them.
Malini Madhavan, MBBS, and colleagues investigated the interaction between cognitive impairment and frailty and oral anticoagulation in determining AF outcomes.
“A complex interplay between AF, cognitive impairment and frailty may increase morbidity and mortality in the elderly,” Madhavan, a cardiac electrophysiologist at Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “Cognitive impairment and frailty may in turn affect management of AF. For instance, frailty and cognitive impairment may adversely affect the effectiveness of oral anticoagulation due to poor compliance and inability to adhere to monitoring requirements or deter a physician from prescribing an oral anticoagulant.”
The researchers analyzed 9,749 patients from the ORBIT-AF study (median age, 75 years; 57% men), of whom 3% were found to have cognitive impairment and 5.9% had frailty.
Patients with frailty were less likely to receive oral anticoagulants compared with patients without frailty (68% vs. 77%; P < .001), Madhavan and colleagues wrote. Patients with cognitive impairment also were less likely to receive oral anticoagulants compared with those without cognitive impairment (70% vs 77%; P = .006).
Both cognitive impairment (HR = 1.34; 95% CI, 1.05-1.72) and frailty (HR = 1.29; 95% CI, 1.08-1.55) were associated with elevated risk for death, the researchers wrote.
Cognitive impairment and frailty had no association with stroke/transient ischemic attack or major bleeding, Madhavan and colleagues wrote.
There was no interaction between oral anticoagulant use, frailty or cognitive impairment, and outcomes including mortality, major bleeding and a composite of stroke, systemic embolism not involving the central nervous system, TIA, MI and CV death, according to the researchers. – by Earl Holland Jr.
Disclosures: Madhavan reports she received consultant fees from Convatec. Please see the study for all other authors’ relevant financial disclosures.
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