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Original research article
Mild cognitive impairment impacts health outcomes of patients with atrial fibrillation undergoing a disease management intervention
  1. Jocasta Ball1,2,
  2. Maja-Lisa Løchen1,3,4,
  3. Melinda J Carrington1,2,4,
  4. Joshua F Wiley5 and
  5. Simon Stewart4
  1. 1Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  2. 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  4. 4Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
  5. 5School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Dr Jocasta Ball; Jocasta.Ball{at}baker.edu.au

Abstract

Objective Mild cognitive impairment (MCI) is prevalent in atrial fibrillation (AF) and has the potential to contribute to poor outcomes. We investigated the influence of MCI on survival and rehospitalisation in patients with chronic forms of AF undergoing a home-based, AF-specific disease management intervention (home-based intervention (HBI)) or standard management (SM).

Methods The Montreal Cognitive Assessment tool was administered at baseline (a score of <26/30 indicated MCI) in patients with AF randomised to HBI versus SM. Post hoc analyses of mortality and rehospitalisations during a minimum 24-month follow-up were conducted in the overall cohort and in each study group separately.

Results Of 260 patients (mean age 72±11, 47% female), 65% demonstrated MCI on screening (34% in SM; 31% in HBI). Overall, the number of days spent alive and out-of-hospital during follow-up (P=0.012) and all-cause rehospitalisation were influenced by MCI during follow-up (OR 3.16 (95% CI 1.46 to 6.84)) but MCI did not influence any outcomes in the SM group. However, survival was negatively influenced by MCI in the HBI group (P=0.036); those with MCI in this group were 5.6 times more likely to die during follow-up (OR 5.57 (95% CI 1.10 to 28.1)). Those with MCI in the HBI group also spent less days alive and out-of-hospital than those with no MCI (P=0.022). MCI was also identified as a significant independent correlate of shortest duration of event-free survival (OR 3.48 (95% CI 1.06 to 11.4)), all-cause rehospitalisation (OR 3.30 (95% CI 1.25 to 8.69)) and cardiovascular disease (CVD)-related rehospitalisation (OR 2.35 (95% CI 1.12 to 4.91)) in this group.

Conclusions The effectiveness of home-based, disease management for patients with chronic forms of AF is negatively affected by comorbid MCI. The benefit of adjunctive support for patients with MCI on CVD-related health outcomes requires further investigation.

  • atrial fibrillation
  • mild cognitive impairment
  • health outcomes
  • disease management
  • program effectiveness

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors All authors contributed to the study design, data analysis, manuscript writing, reviewing and editing.

  • Funding The SAFETY Trial was funded by a National Health and Medical Research Council of Australia Program Grant (519823). JB (APP1112829) and SS (APP1041796) are supported by the National Health and Medical Research Council of Australia. JB is also supported by a postdoctoral fellowship (Award Reference 100950) from the National Heart Foundation of Australia, and MJC is supported by a Future Leader Fellowship (Award Reference 100802) from the National Heart Foundation of Australia. Supported in part by the Victorian Government’s Operational Infrastructure Support Program.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the human research ethics committee(s) associated with each of the study sites (hospitals).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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