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Cognitive function and anticoagulation control in patients with atrial fibrillation.

Publication ,  Journal Article
Flaker, GC; Pogue, J; Yusuf, S; Pfeffer, MA; Goldhaber, SZ; Granger, CB; Anand, IS; Hart, R; Connolly, SJ ...
Published in: Circ Cardiovasc Qual Outcomes
May 2010

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.

Duke Scholars

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

May 2010

Volume

3

Issue

3

Start / End Page

277 / 283

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surveys and Questionnaires
  • Risk Factors
  • Middle Aged
  • Male
  • Insulin
  • Humans
  • Female
  • Drug Interactions
 

Citation

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Flaker, G. C., Pogue, J., Yusuf, S., Pfeffer, M. A., Goldhaber, S. Z., Granger, C. B., … Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE) Investigators, . (2010). Cognitive function and anticoagulation control in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes, 3(3), 277–283. https://doi.org/10.1161/CIRCOUTCOMES.109.884171
Flaker, Greg C., Janice Pogue, Salim Yusuf, Marc A. Pfeffer, Samuel Z. Goldhaber, Christopher B. Granger, Inderjit S. Anand, Robert Hart, Stuart J. Connolly, and Stuart J. Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE) Investigators. “Cognitive function and anticoagulation control in patients with atrial fibrillation.Circ Cardiovasc Qual Outcomes 3, no. 3 (May 2010): 277–83. https://doi.org/10.1161/CIRCOUTCOMES.109.884171.
Flaker GC, Pogue J, Yusuf S, Pfeffer MA, Goldhaber SZ, Granger CB, et al. Cognitive function and anticoagulation control in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2010 May;3(3):277–83.
Flaker, Greg C., et al. “Cognitive function and anticoagulation control in patients with atrial fibrillation.Circ Cardiovasc Qual Outcomes, vol. 3, no. 3, May 2010, pp. 277–83. Pubmed, doi:10.1161/CIRCOUTCOMES.109.884171.
Flaker GC, Pogue J, Yusuf S, Pfeffer MA, Goldhaber SZ, Granger CB, Anand IS, Hart R, Connolly SJ, Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE) Investigators. Cognitive function and anticoagulation control in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2010 May;3(3):277–283.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

May 2010

Volume

3

Issue

3

Start / End Page

277 / 283

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surveys and Questionnaires
  • Risk Factors
  • Middle Aged
  • Male
  • Insulin
  • Humans
  • Female
  • Drug Interactions