Among patients with permanent atrial fibrillation, cognitive impairment may be more common in those with suboptimal antithrombotic therapy, oral anticoagulation, or heart rate control, according to findings published in the Journal of Stroke and Cerebrovascular Diseases.

Atrial fibrillation is known to increase the risk for stroke and to be associated with the progression of cognitive impairment. Oral anticoagulant therapy (OAT) plays a key role in the prevention of cardioembolic events in patients with atrial fibrillation.

In this retrospective cross-sectional study conducted from September 2013 to May 2014, the data of 212 consecutive outpatients (median age, 80 years; interquartile range, 75-84 years; 45% men) with permanent atrial fibrillation lasting > 1 year were examined. The Short Portable Mental Status Questionnaire (SPMSQ) was used to assess cognitive impairment (ie, number of errors on the questionnaire ≥5). History of cerebrovascular/cardiovascular events and associated risk factors, pharmacologic treatments, type of antithrombotic therapy, the time in therapeutic range (TTR; for patients treated with warfarin), and the degree of heart rate (HR) control were all examined.

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In this cohort, 38% of patients had a history of cerebrovascular or cardiovascular event, 94 and 93 patients were taking warfarin with TTR ≤60% and with TTR >60%, respectively (44% for both). TTR in participants with vs without cognitive impairment was significantly lower (P <.001). Receiver Operative Characteristics curve analysis indicated that TTR was associated with cognitive impairment (area under the curve, 0.85±0.03; 95% CI, 0.77-0.88; P <.0001). Independent associations between cognitive impairment and:  previous cerebrovascular or cardiovascular events (odds ratio [OR], 7.24; 95% CI, 1.37-38.25; P =.020), aspirin therapy vs anticoagulant therapy (OR, 24.74; 95% CI, 1.27-482.12; P =.034), warfarin use with TTR ≤60% (OR, 21.71; 95% CI, 4.35-108; P <.001), and an average daily HR either <60 bpm or >100 bpm (OR, 6.04; 95% CI, 1.09-33.29; P =.039) were established in a multivariate logistic regression analysis.

Limitations of the study include the small sample size, inability to establish a causal relationship between the variables, and the fact that none of the participants were treated with non-vitamin K antagonist oral anticoagulants (NOACs).

“Future prospective studies are needed to assess whether adequate OAT therapy (vitamin K antagonists with high TTR values or NOACs) and good heart rate control could reduce the onset of cognitive impairment in patients with permanent [atrial fibrillation]. Several studies are ongoing, and data will be available in a few years,” concluded the authors.


Petroni R, Msgnano R, Pezzi L, Petroni A, Di Mauro M, Mattei A, et al. Analysis of risk factors indepednetly associated with cognitive impairment in patients with permanent atrial fibrillation: A cross-sectional observational study (published online May 17, 2020). J STROKE CEREBROVASC.