Document Detail


Cognitive function and anticoagulation control in patients with atrial fibrillation.
MedLine Citation:
PMID:  20233976     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with atrial fibrillation usually are elderly and may have cognitive dysfunction. These patients may receive less effective oral anticoagulation, resulting in more vascular events and bleeding. METHODS AND RESULTS: In an analysis of cognitive function associated with the time in therapeutic range (TTR) in the Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events, 2510 patients (mean age, 71+/-9.5 years) from 27 countries completed the Mini-Mental State Examination (MMSE). Of these patients, 171 (6.8%) had an MMSE score <24, suggesting dementia, and 194 (7.7%) had intermediate scores of 24 to 25. Low MMSE scores were correlated with a low TTR. Even mild cognitive impairment was associated with a TTR below the median (<65%). Patients with an MMSE score <26 had more vascular events (6.7% versus 3.6% per 100 patient-years; P=0.002) and more bleeding (9.6% versus 7% per 100 patient-years; P=0.04). After controlling for TTR, the MMSE no longer conferred increased risk, suggesting that if improved anticoagulation was provided, vascular events and bleeding would be reduced. Other independent factors associated with a TTR <65% were region of the world, recent initiation of vitamin K antagonist, type of anticoagulant, and concurrent use of amiodarone or insulin. After adjustment for these factors, lower MMSE scores still predicted a reduced TTR. CONCLUSIONS: Cognitive dysfunction is common in elderly patients with atrial fibrillation and is related to less effective anticoagulation and more vascular events. The MMSE identifies patients with atrial fibrillation in whom extra efforts are needed to maintain effective anticoagulation and improve outcomes. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00243178.
Authors:
Greg C Flaker; Janice Pogue; Salim Yusuf; Marc A Pfeffer; Samuel Z Goldhaber; Christopher B Granger; Inderjit S Anand; Robert Hart; Stuart J Connolly;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-16
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  3     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-20     Completed Date:  2010-09-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  277-83     Citation Subset:  IM    
Affiliation:
University of Missouri-Columbia, USA. flakerg@health.missouri.edu <flakerg@health.missouri.edu>
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00243178
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Amiodarone / therapeutic use
Anticoagulants / therapeutic use*
Atrial Fibrillation / drug therapy,  epidemiology*,  psychology*
Comorbidity
Dementia / drug therapy,  epidemiology*,  psychology*
Drug Interactions
Female
Humans
Insulin / therapeutic use
Male
Middle Aged
Questionnaires
Risk Factors
Treatment Outcome
United States
Chemical
Reg. No./Substance:
0/Anticoagulants; 11061-68-0/Insulin; 1951-25-3/Amiodarone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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