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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?
Methods:
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).
Results:
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.
Conclusions:
The authors concluded that AF is associated with cognitive and functional decline regardless of whether or not there have been clinically-apparent strokes.
Perspective:
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.
Keywords: Prevalence, Cognition, Stroke, Multivariate Analysis, Benzimidazoles, Composite Resins, Dementia, Ramipril, Benzoates
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