Increased Risk of Cognitive and Functional Decline in Patients With Atrial Fibrillation: Results of the ONTARGET and TRANSCEND Studies

Study Questions:

Is atrial fibrillation (AF) associated with dementia?


This was a post-hoc analysis of data from two clinical trials that examined the effects of telmisartan or telmisartan and ramipril on cardiovascular outcomes. There were a total of 31,506 patients (mean age 66.5 years). Cognitive function was measured with the Mini-Mental State Examination (MMSE) at baseline and at 2 years, and a median of 56 months of follow-up. The primary outcome was a composite of a decline in MMSE score by ≥3 points, new dementia, inability to independently perform activities of daily living (ADL), and admission to a long-term care facility (LCF).


AF was identified at baseline or during follow-up in 3,068 patients. The prevalence of stroke during follow-up was 8.5% in patients with AF compared to 4% in patients without AF. The composite primary outcome was more prevalent among patients with than without AF (34.2% vs. 26.1%). By multivariate analysis, AF was associated with cognitive loss (hazard ratio [HR], 1.14), new dementia (HR, 1.3), loss of independence in performing ADLs (HR, 1.35), and admission to an LCF (HR, 1.53), independent of antithrombotic therapy or history of stroke.


The authors concluded that AF is associated with cognitive and functional decline regardless of whether or not there have been clinically-apparent strokes.


Prior studies on AF as a risk factor for cognitive decline have reported conflicting results. The present study makes a strong case for AF adversely affecting cognitive function, even in the absence of overt strokes. This may provide a rationale for favoring a rhythm-control strategy over a rate-control strategy in patients with AF.

Clinical Topics: Novel Agents, Sleep Apnea

Keywords: Prevalence, Cognition, Stroke, Multivariate Analysis, Benzimidazoles, Composite Resins, Dementia, Ramipril, Benzoates

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