Atrial fibrillation and cognitive function in patients with heart failure: a systematic review and meta-analysis

Abstract

Cognitive impairment and dementia are established complications of heart failure (HF) in adult patients and impair medication adherence and self-care. Atrial fibrillation (AF) is suggested to play an independent role in the cognitive decline in patients with HF. The objective of this systematic review was to assess the effect of AF on cognitive function in these patients. Medline (PubMed), Scopus, and the CENTRAL databases were queried from their inception up to April 30, 2016. The search included primary research articles evaluating the effect of AF on cognition in HF patients. There were five eligible studies, including a total of 1670 patients with HF; of these, 449 (26.9%) had AF. Different AF types were studied, including persistent, paroxysmal, or permanent. Four cognitive tests were used to assess cognitive function (Mini-Mental State Examination, Short Portable Mental Status Questionnaire, Modified Mini-Mental Examination, and Montreal cognitive assessment tool). Using the inverse variance method and a random effects model, we observed that presence of AF was significantly associated with increased risk of cognitive impairment in HF patients (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.30-2.87), although with significant heterogeneity (I = 39%). This heterogeneity can be attributed to the different populations and types of AF studied as well as to varying cognitive assessment methods. Concomitant AF may exacerbate cognitive dysfunction in HF patients. However, data are sparse and heterogeneous. Well-designed, prospective studies are needed to (a) establish a causative link and (b) identify the underlying mechanism in order to design appropriate interventions to attenuate risk of cognitive impairment in patients with HF.

Increased myocardial extracellular volume assessed by cardiovascular magnetic resonance T1 mapping and its determinants in type 2 diabetes mellitus patients with normal myocardial systolic strain

“…Nevertheless, a large study reported that there was no difference in the longitudinal strain between patients without albuminuria and controls [ 21 ]. Additionally, the use of the STE method to assess myocardial strain has several limitations, including a lower signal-to-noise ratio, weak acoustic windows, and through-plane motion artifacts [ 22 , 23 ]. Furthermore, CMR tissue-tracking technology can assess cardiac deformation parameters with post-processing for cine images, which have a higher signal-to-noise ratio, and utilizes routine cine images without requiring any additional scan time [ 22 , 24 ].…”

Effect of self-management interventions on complications of atrial fibrillation: A clinical trial

“…To our best knowledge, information obtained from studies can guide upcoming researches and provide well-being procedures for effective self-management interventions of AF [1,3,4]. Therefore it is required to improve and recover the life condition of patients with chronic diseases including AF.…”

“…Atrial fibrillation (AF) as the most common cardiac arrhythmia in 1-1.5% of general population [1]. The prevalence rate of AF is 0.5% in individuals aged 40-50 years old to 15% in 80 years old with higher risk of morbidities in men than in women [2,3]. It is associated with a five-fold greater risk of thromboembolism and stroke and other complications including neurologic injury, organ failure, and emergency department (ED) re-admissions [1,2].…”

Prevalence and Progression of Cognitive Impairment in Atrial Fibrillation Patients after Treatment with Catheter Ablation or Drug Therapy

“…Although reduction in cardiac performance remains an important and impactful complication of arrhythmia, there seems to be increasing evidence that AF is also independently associated with cognitive decline and dementia even without clinical history of stroke [1,[4][5][6][7]. is effect was revealed in AF patients both with and without coexisting heart failure [6,8,9]. However, pathogenesis of cognitive dysfunction in AF patients is still in discussion.…”