Cognitive impairment, age, quality of life, and treatment strategy for atrial fibrillation in older adults: The SAGE-AF study.

Autor: Karnik AA; Evans Department of Medicine, Cardiovascular Medicine Section, Arrhythmia Service, Boston University School of Medicine, Boston, Massachusetts, USA., Saczynski JS; Bouvé College of Health Sciences, Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts, USA., Chung JJ; Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA., Gurwitz JH; Meyers Primary Care Institute and Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA., Bamgbade BA; Bouvé College of Health Sciences, Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts, USA., Paul TJ; Meyers Primary Care Institute and Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA., Lessard DM; Division of Epidemiology of Chronic Diseases, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA., McManus DD; Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA., Helm RH; Evans Department of Medicine, Cardiovascular Medicine Section, Arrhythmia Service, Boston University School of Medicine, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2022 Oct; Vol. 70 (10), pp. 2818-2826. Date of Electronic Publication: 2022 Jun 23.
DOI: 10.1111/jgs.17886
Abstrakt: Background: Atrial fibrillation (AF) treatment includes anticoagulation for high stroke risk individuals and either rate or rhythm control strategies. We aimed to investigate the impact of age, geriatric factors, and medical comorbidities on choice of rhythm versus rate control strategy in older adults.
Methods: Patients with AF aged ≥65 years with CHA 2 DS 2 VASc score ≥2 and eligible for anticoagulation were recruited for the Systematic Assessment of Geriatric Elements-AF (SAGE-AF) prospective cohort study. An interview that included measures of HRQoL, cognitive function, vision, hearing, and frailty was performed. The association between these elements and AF treatment strategy was examined by multivariable logistic regression models.
Results: One thousand two hundred forty-four participants (mean age 76 years; 49% female; 85% non-Hispanic white) were enrolled. Rate and rhythm control were used in 534 and 710 participants, respectively. Compared to participants <75 years, those ≥75 were more likely to be treated with a rate control strategy (age 75-84 adjusted odds ratio [aOR] 1.37 [95% CI 0.99, 1.88]; age 85+ aOR = 2.05, 95% CI 1.30, 3.21). Those treated with a rate control strategy were more likely to have cognitive impairment (aOR = 1.50, 95% CI 1.13, 1.99), and peripheral vascular disease (PVD) (aOR = 1.82, 95% CI 1.22, 2.72) but less likely to have visual impairment (aOR 0.73 [0.55, 0.98]), congestive heart failure (CHF; aOR 0.68 [0.49, 0.94]) or receive anticoagulation (aOR 0.53, 95% CI 0.36, 0.78).
Conclusion: Older age, cognitive impairment, and PVD were associated with use of rate control strategy. Visual impairment, CHF, and anticoagulation use were associated with a rhythm control strategy. There was no difference in HRQoL between the rate and rhythm control groups. This study suggests that certain geriatric elements may be associated with AF treatment strategies. Further study is needed to evaluate how these decisions affect outcomes.
(© 2022 The American Geriatrics Society.)
Databáze: MEDLINE
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